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114. Vagal Nerve Stimulation for Anxiety with Dr. Hool

Written by Carrie Bock on . Posted in Anxiety, Podcast Episode.

In this episode, Carrie interviews Dr. Nicholas Hool about his personal struggle with anxiety and how it led to the development of VeRelief™.

Episode Highlights:

  • How vagal nerve stimulation works and its effectiveness in relieving stress and anxiety.
  • Why VeRelief is a good option for managing anxiety
  • The evolution of the VeRelief product line, from its initial design to the upcoming third generation.
  • The differences between VeRelief and other anxiety relief devices on the market.

Explore VeRelief through our affiliate link.

Episode Summary:

Welcome to episode 114 of Christian Faith and OCD. I’m Carrie Bock, your host. Today’s episode features a unique guest, Dr. Nicholas Hool. With a PhD in biomedical engineering, Dr. Hool is here to share his personal journey with anxiety and the innovative product he developed to help others manage their anxiety.

In our conversation, Dr. Hool reveals how his experience with anxiety began in high school while pursuing a career in competitive golf. As he faced intense pressure and performance anxiety, he explored various methods to manage his stress, from sports psychology to medication. Despite some initial success with visualization techniques, he found long-term solutions challenging to maintain.

Dr. Hool’s quest for a more effective solution led him to study biomedical engineering. His research focused on the vagus nerve, a key player in regulating our stress response. He explains how vagus nerve stimulation can quickly balance the nervous system, offering a non-drug approach to anxiety relief.

Dr. Hool’s breakthrough came with the development of a handheld device that stimulates the auricular vagus nerve using gentle electrical impulses. This device aims to enhance heart rate variability, a measure of nervous system balance, helping users recover from stress and anxiety more effectively.

Tune in to discover how Dr. Hool’s innovative approach could provide relief for those struggling with anxiety and how his personal journey led to this groundbreaking solution.

Summary

Welcome to Christian Faith and OCD episode 114. I am your host, Carrie Bock, and on the show, we’re all about reducing shame, increasing hope, and developing healthier connections with God and others. We have a unique interview today. Here I have with me Dr. Nicholas Hool who has a PhD in biomedical engineering, and he can explain a little bit more about that later. He’s going to talk about his own personal experience with anxiety that led him on a journey to develop a product that will help others with their anxiety as well. 

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Carrie: Welcome to the show.

Dr. Hool: Yes. Thanks for having me.

Carrie: What is your experience with anxiety being on a personal level?

Dr. Hool: I have some experience that’s going to be different than a lot of other people, but my kind of first taste of it was in high school.

I was a competitive golfer growing up, played golf since I could walk basically, but decided I wanted to really pursue golf as a career. Probably when I was, or maybe around 14 years old, I thought I want to do this. I want this to be my sport. It would be awesome to go pro someday like a lot of kids think when they play sports, they want to go pro.

And I was good. I won some tournaments, traveled the country in high school. And then for whatever reason, probably when I was 16, 17, maybe it was just suddenly like the thought of this is real. I got a couple of years left and then it’s like, it’s the real deal. Suddenly I started thinking about it more. I started contemplating the future.

I started contemplating my own performance and everyone’s watching you. Like now is the time you have to perform well. I never thought about the future before.  It was just exciting, right? When you’re a kid, you’re just having a good time, but then suddenly, I mean, I think that’s what anxiety is, right?

You’re thinking about the future in a negative way. You’re afraid, you’re worrying about things that you don’t either typically worry about, or I guess what they say is a typical person doesn’t really worry about it that much to the degree that you’re worrying about it. I just started worrying about the future all the time.

And I’m just like, “why am I worried so much about this?” It wasn’t so much the worry that affected me. I think everybody to some degree worries about their future, right? What if I fail? What if it doesn’t work out? It started manifesting as these. I want to call them panic attacks. They were just severe stress responses.

When I was on the golf course, I would be on the first tee and just heart beating out of my chest. I think it’s normal to be nervous, right? Like everyone gets nervous, but I’d been nervous before I dealt with that in every tournament. This was a lot more severe. Suddenly college coaches are watching, maybe they’re not even watching it.I’m just playing by myself. Suddenly I’m in my head. I’m going into that stress response again. I’m just like, what the heck is going on?

Carrie: It’s a lot of pressure in those sports arenas, the better you get, the more competition you encounter. All of sudden you’re playing around people that are as good as you are better. And there’s a lot going on there.

Dr. Hool: There is a lot going on, but when you think about it, you’re still just doing what you do. It’s me playing golf. That’s it. I’m not playing another person’s golf round. I’m playing my golf round. I’m the one that put all that pressure on myself by thinking about it, by worrying about it.

I think that’s what a lot of people do with just life in general. People are so worried about what if I fail or what is this person going to think of me if I say this or do that. And that causes the stress response that causes an anxiety.

Carrie: Almost like your body is responding as though there’s a bear or a lion in front of you instead of a gold tee.

Dr. Hool: Yes, exactly. And a lot of it, it’s just in your own head. I mean, it’s so hard to just get that out. It’s not like you can just say, “Oh, well, don’t think about it.” Obviously that’s not how it works. If left undealt with, it will have a major negative impact on the trajectory of your life. So for me, I kind of burned out and I didn’t pursue golf after I graduated high school.

I could have gone to play at a lot of different schools.  I was still good, but it was just knowing how good I was. At the time when I graduated, how much I was struggling, it was just like, “man, I don’t feel like this is going to work out. The guys that were going pro at the time were so good.”

And looking at that, I’m like, “man, I’m so far from that.” Even though I’m good,I  just kind of struggle with anxiety and the fear and all that just took a toll. It’s like, “yes, it’s probably best to do something different.”

Carrie: What did you try to manage it or get rid of it or deal with it?

Dr. Hool: When I was 16, I went to a sports psychologist and did the whole thing like lay on the couch, let’s go through progressive muscle relaxation. It lets get you a nice state of calm. And he would lead me through these visualizations of just being on the golf course and playing perfect golf. If I hit a bad shot, what does that look like to recover from that? And then even if I’m in a high pressure situation, trying to visualize my body responding in an ideal way compared to how I typically respond.

And just doing that over and over in the mind was sort of reprogramming my thought process. It worked incredibly well when I was practicing it. The key is that I did it for about a month, probably a few times a week, and it would take me about an hour to do this. I would lay on the couch. I go through my progressive muscle relaxation, get in that optimal state of visualization, and then I would actually do the visualization, which took time. And because it had an almost like a pretty immediate effect, I would do a visualization and I go and play golf. I’m really calm and focused. I thought like, Oh, I cured myself. I’m good. I don’t need to do this anymore. So I stopped doing it. And of course, once you stop doing it, the tendencies come back, especially if you’ve only done it a few times.

I kind of just lost discipline, I guess. I didn’t commit to it. It takes a lot of time and mental effort to do that visualization, to do that relaxation. You have to go find a quiet environment. I got to lay down. If I have racing thoughts, I have to first calm those down before I can even focus on the positive.

That’s hard to do. I was actually prescribed clonazepam for a month, which is a benzodiazepine anti-anxiety drug. Which is really powerful, and I have no idea why the guy prescribed it to me. I did not need that like it wasn’t so bad, but the protocol is you would take it about an hour or so before you go do something that is supposed to freak you out and cause a lot of anxiety, because it takes about an hour to kick in.

It worked really well to get off the first tee when I would take it an hour before taking off. But then it stayed in my system for four hours and I was sluggish. I wasn’t cognitively focused and I wasn’t performing my best mentally. And I was like, that’s not a good option. Like, I don’t want that in my system when I’m trying to play golf.

The available solutions that I tried just weren’t effective, really. They weren’t what I needed. The most effective was the visualization, but, it’s just so hard to commit to that long term because it takes so much time. And like in today’s modern world of just always on the go, who has an hour to just sit down in a quiet space and meditate and focus, even if you had the time to do it. You have to have the ability to do it.

Carrie: It’s a Yes. It’s a skill that you have to learn and train

Dr. Hool: It’s really hard. You can’t just download a meditation app and be like, “Alright, I’m going to do meditation now.” That’s not going to work. It’s a skill. It’s something you get to practice all the time. If you’re not disciplined, it’s just not really going to work out long term.

Carrie: How did this lead you into studying biomedical engineering and learning about the vagus nerve and vagus nerve stimulation?

Dr. Hool: I just had this thought of if I’m on the golf course and I’m fine, and then I fight or flight response can kick in in a matter of seconds. It just hits you out of note. I was thinking, I’m like, if it can just turn on like the flip of a switch, why can’t I turn it off like the flip of a switch doing these meditations and these progressive muscle relaxations and this breathwork stuff that wasn’t the off switch. It just wasn’t having that deep immediate effect that I needed. Neither were drugs, right? Drugs still take an hour to kick in. Those don’t even have very solid effects, but in those moments, it’s not gonna have any effect on me. I thought, let’s go study that response.

There’s going to be something out there that can shut it off fast. I always liked math and engineering, so I chose biomedical engineering because I literally just wanted to study that what is happening in your body physically when that fight or flight response flips on and ultimately to understand it. So I could turn it off.  I just turn it off on command. It was 8 straight years of biomedical engineering went into undergrad. So for four years, I learned all the basics, and then in my PhD program, that’s where I got really specific and started doing actual research with different technologies and ultimately arrived at the one we have today.

Carrie: Tell me about the vagus nerve and its role in that fight, flight, or freeze response. I was doing a little bit of mild Googling on the vagus nerve, and it turns out that the term vagus is Latin for wandering, which I found interesting. So this is a nerve that wanders in our body.

Dr. Hool: The vagus nerve, it’s one of the 12 cranial nerves in the body. It’s called the wandering nerve because it wanders throughout your entire upper body. It’s the largest and the longest of your cranial nerves. It plays a role in essentially maintaining what’s called homeostasis, keeping your body and your nervous system in a state of balance. There’s a lot of things that it covers, right?

It helps digestion. It helps with heart-related issues, cardiovascular things. It helps with mental health. It just keeps your overall nervous system in a state of balance. And the nervous system is made up of two separate components. You have the sympathetic nervous system, and the parasympathetic. The sympathetic is your fight or flight response.

When your sympathetic is active, it sends a signal to your body saying it’s time to speed up and to tense up. That’s where you get that racing heart rate. Your hands are jittery. Blood pressure might go up. Breathing rate goes up. You’re familiar with it, right? It’s that fight or flight response. Not comfortable to be in unless you’re actually running for your life.

Carrie: And then it’s helpful and purposeful and useful at that point.

Dr. Hool: Parasympathetic is the opposite. It’s the rest and digest. It’s what helps you stay calm after you eat a nice big meal. Usually, you’re really sluggish, and you don’t want to move around because you’ve eaten a meal.

That’s the rest and digest state. Your body’s going into a state of just chill so that you can digest your food. You can recover from stress. You can rest. Those states are always fluctuating all the time, no matter what. And so what? The vagus nerve’s main job, it basically shifts you out of fight or flight.

So when your fight or flight is really active, the vagus nerve’s job is to help bring that down to rebalance the nervous system. In my research, I learned that it’s not so much that the vagus nerve increases parasympathetic, but instead, it decreases the sympathetic, and so that’s how it balances. That’s why it’s also really good if you’re in a fight or flight state where you’re having an anxiety attack or panic or just stress stimulating your vagus nerve is an almost instant way to bring that stress response down because that’s its main job. And I learned that in research, just reading all these research papers, learning about the vagus nerve. And to me, it was like, that’s what I needed right there. If I had something that could just stimulate my vagus nerve on the golf course, It would pull me out of that response, and I could focus again.

I could be calm and perform. I can fall asleep finally, or I’ll be less irritable around my loved ones after I’m stressed out or something that kind of became what I committed to was. Let’s dive into vagal nerve stimulation and see if we could develop this out for the high performing individuals like the athletes, but really the everyday person that just wants something safe, nondrug, and effective to calm them down quickly.

Carrie: Can you tell us a little bit more about how the product that you have is used for vagal nerve stimulation?

Dr. Hool: We developed a little handheld device. This is kind of what it looks like if people are watching the video, but what it is is it uses electricity, so gentle electrical impulses to directly activate a small branch of the nerve found just under your ear.

There’s two areas you can target the vagus nerve noninvasively.  That’s what’s called the auricular vagus nerve, which is around the ear, and then you have the cervical vagus nerve, which is on the front side of the neck. The cervical region of the vagus nerve is a little deeper in the neck, and it’s close to baroreceptors, which control blood pressure, and it also has direct projections to your heart.

It’s a higher risk location to stimulate because it can cause a sudden drop in heart rate and the pressure applied can also cause a sudden drop in blood pressure, which, if you deal with any type of heart condition or have a blood pressure condition, it can be dangerous to do that, whereas auricular is farther away from those regions. So there’s no risk in dropping blood pressure, and there’s no direct projections to the heart with the auricular. There’s no heart-related side effect. That was my first kind of focus was safety first. We know the vagus nerve can have this effect, but we need it to be safe. So, auricular was the obvious choice.

Now, the other benefit that we learned later in research was when you stimulate the auricular vagus nerve with electricity, You see an increase in, it’s called heart rate variability. Heart rate variability is just a way to measure your heart rate in such a way that it reveals the state of your nervous system.Heart rate is just measuring how many beats per minute your heart rate is beating at. Heart rate variability is a measure of the fluctuation of your heart rate over time. So, when you have a large fluctuation in your heart rate, that’s a good thing because it means your body is in a state where it can adapt to changes very easily, but if your heart rate is not changing over time, it’s like kind of stuck in the same heart rate over some period of time. That means your body’s not capable of adapting to change. If you go into that fight or flight state, you typically stay there for a long time. That’s why you can’t recover. If you have a low heart rate variability, what a regular vagal nerve stim does is literally in 60 seconds, we can see, we could double your heart rate variability, depending on what it is when you first start. That’s just an indicator that we’re shifting you out of that fight or flight state, literally within seconds versus cervical. We don’t see the same effects of heart rate variability.

Carrie: If you have a low heart rate variability, does that mean that you usually have a more elevated heart rate? You’re more anxious and it stays at that higher heart rate?

Dr. Hool: Not necessarily. If you think about a true fight or flight response, you’re walking in the woods and suddenly you see a bear start chasing you. Your heart rate is going to go up, but it’s going to stay up. It’s not going to come down and then go back up. It’s going to stay there. So the variability is tiny when your heart rate is beating really fast.

When you’re just chilling at home on the couch watching TV, if you monitor your heart rate, you’ll see that it might be 60, and then it might go up to 70, maybe 80, and then it might come back down to 60, and it’s going to do that over time. That’s just how it is, but if you’re chilling on the couch and your heart rate is just stuck at like 70, that’s not good. That means your nervous system is kind of in that fight or flight state, even though your heart rate may not be high. The variability is really low, which suggests your nervous system is not balanced. You’re not in a healthy state. Beyond just being stressed and anxious, an imbalanced nervous system affects your ability to heal from other conditions, from sickness.

You don’t digest things properly. You can’t recover if you have an injury. And so heart rate variability is just a great way to quickly take a snapshot of, “Is my body in a rest and digest state or am I in a state where it’s being resistant to healing and I’m more prone to getting stressed and anxious?”

Well, we’ve been able to demonstrate on almost all of our step patients and research was when you stimulate the auricular vagus nerve, you see an instant increase in the H.R V., which is why we always get people saying the device helps them fall asleep faster. They recover from a stressful experience faster.

We have a lot of patients with PTSD and panic disorder that use our product, pull them out of that panic attack. And then when used as part of a daily routine, it definitely helps decrease the effects of anxiety. And I say the effects of anxiety because it’s not going to eliminate your worries. If you’re someone who’s a lot and you’re always afraid of the future, you’re contemplating negative thoughts, it’s not going to drive those away.

However, it will lessen the impact on your body that those negative thoughts have, which is still a good thing for things like general anxiety. I highly recommend people learn meditation like the right way, but you can use verily to accelerate your meditation sessions because the problem that I was having was it takes me 30 minutes just to calm my mind, calm my body before I can actually do a real meditation. With the very late device, it does it. It does all the work for you. It’s literally pulling my body out of fight or flight and putting it into that ideal meditative state in a matter of minutes. And now I can meditate again. We have a lot of psychologists and counselors who will sit with their patients in a session. “Here use this for the first five minutes of our session, and then I’ll walk you through our counseling, and we’ll get to the core issue of your anxiety.” It’s a great supplement or something like that.

Carrie: I liked what you talk about in terms of chronic health conditions and our body having difficulty healing.

If our nervous system is out of balance, there are a lot of people out there that they’ve been to several doctors and the doctors are saying, “I don’t know how to help you anymore,” or “we’re not really sure where this is coming from.” Yes, we can say that you’re having these symptoms. I think there’s a lot that goes on in a day-to-day in our nervous system that we aren’t necessarily always cued into or aware of.

When people are having heightened levels of anxiety, sometimes they’re recognizing that because it’s coming in the form of an anxiety attack or a panic attack. Sometimes they’re not aware of that because they’re just living at a state of chronic stress and it’s now taking a toll and they’re having things like headaches or digestive issues or other chronic pain or health conditions.

I think that’s important for people to recognize that mental health piece in there. I like what you said about utilizing this to help wind down for sleep. You and I got connected some time ago, and you guys actually sent me a Verilief device, and when I started using it was before I went to bed, kind of to help, like, wind down my mind, like wind down my body.

Sometimes it can be hard depending on what you’re doing before you try to go to sleep to get yourself to a more wound down state. But I’ve also used it if I have a really difficult session with a client or we’ve just processed some really hard trauma and maybe that’s something that I still feel like I’m carrying around with me.

It’s nice for me to be able to release that stress and take those few minutes to just be able to breathe and let go. And so I have found it helpful and have recommended it to some of my clients. Now, I know that you guys are doing pre-orders for the third generation V Relief. So can you tell us about some of the changes that you’ve made over time to kind of tweak and make perfections to the product?

Dr. Hool: We’re a team of engineers and designers, core, which just means we are obsessed with building the best product. It hurts us to launch something that we’re like, “Oh, we can build something better.” Although we still have to ship a product. We can’t just sit in our lab all day and just keep making stuff. But the first product we launched was just a handheld device.

I want to say maybe late 2021, early 2022. That was just through word of mouth and connections we had with local doctors, but the usability of it was not great. It was a little bit big and bulky before we were ready to really launch this thing. Let’s redesign it. Let’s make it smaller.

We’re taking pre-orders for that. We weren’t expecting to take pre-orders this early, just because our gen twos sold out way faster than we thought they would over Christmas. We thought we’d have an easy transition into the next gen. But people are rushing to buy this because they’re starting to realize like, “Oh, man, this thing is legit.”

There’s not a lot of great options out there to take care of your nervous system, right? There are these really expensive machines that are good, but not affordable. And then the low-cost ones are ineffective. You’re just kind of getting these knockoff products that don’t have any major impact on your nervous system. It’s definitely a powerful, effective product. And for the price point, it’s kind of unbeatable.

Carrie: Yes. That’s awesome. You guys have it discounted right now for the presale and you’re expecting to ship around April. Is that right?

Dr. Hool: Yes, so right now we’re offering a $100 discount for those who pre-order. That discount will start to be reduced as we get closer to shipping.

We want to reward customers who wait the longest with the best deal, but yes, for now, you can just get it and save $100 to get it for $299 as opposed to $399. They’re being made right now, about 50 percent of the batch is complete. We just have to wait on some other manufacturing things to come through, but yes, they’re coming.

Carrie: This is one of the things I think that impressed me the most about your company and caused me to become an affiliate was your 60-day money-back guarantee. Tell us about that.

Dr. Hool: Basically, every product that we looked into for calming people down, helping the nervous system, they’re giving these 21 to 30-day warranties or money-back guarantees. I’m like, “That’s so small”. If you don’t have time to use it in every situation, right? People are traveling or doing stuff, so  we give people 60 days just because we know 30 days is not enough. Use it for two whole months. If you don’t get the improvements at some point within two months, probably not going to have an impact.

It’s like you’ve got plenty of time to try it. We talk to everybody that reaches out to us. If they have any challenges, any help at all with understanding how to apply this to their own lives. We’ll literally chat with you. We’ll say, tell us about your routine. What do you do currently? What’s your day-to-day look like? We’ll create protocols for you. We recommend using it. Combine it with this modality or that supplement and you’re going to see great results. We’re here to really make sure that this works for people and it does, right? As long as you just don’t give up trying, like we’ll make it work for you.

Everybody has a vagus nerve. Every vagus nerve responds to stimulation. You just have to work with it a little and get a feel for how to optimize it for each individual. And we work with people to do that.

Carrie: Also I wanted to mention to you when you’re talking about the electrical stimulation, it’s not like you’re getting zapped. For me, it feels like a little vibrating, like tingly feeling near your ear, so it’s not painful or anything of that nature if you’re using it properly. 

Dr. Hool: That was our big engineering feature that we came up with. At the time we were designing them, all these electrical stimulators were very sharp. For the auricular, there were all these ear clip electrodes and tiny little surface area electrodes that just shock your ears. It’s so uncomfortable. And we’re like, “We have to make it feel good.” We tested a bunch of different materials. I mean, we shot ourselves all day long, trying to find something that was comfortable, and we found a really good mixture of materials. We use a certain ingredient that kind of hydrates your skin, so when you’re using it, it’s actually got a skin hydration component to it, which is what makes it a lot more comfortable than a standard electrode that doesn’t have those properties.

Carrie: The high cost of being an entrepreneur, lots of electrical shocks to ear.

Dr. Hool: Yes, all kinds of stuff. I’m not as bold as my electrical engineers. He has done things. Hey, you have some scars that are going to last forever. That’s like, “Dude, you’re crazy, man.” Those people, they love doing stuff. 

Carrie: Gotcha. Are you familiar with the Apollo device?

Dr. Hool: Yes, very familiar. I see advertisements for it on Facebook. 

Carrie: I really know about zero about it, and I didn’t know if you wanted to say anything about that or just leave that out of it, but I’m curious, what does it do compared to what VeriLief does?

Dr. Hool: It’s a different value that they’re delivering. What Apollo does, at least what their technology does, skin vibration, it’s more of a mild calming effect for a long time. Think of it like an SSRI. An SSRI is something you take every day, has a long, mild effect, keeping you calm, but it’s not like a rescue drug. 

If you’re in the middle of a stress response, you don’t take an SSRI, you take a Benzodiazepine. The Benzos are strong. We’re going to get to it, calm you down fast, even though those still take time to kick in. That’s really the difference. 

Apollo is something you wear kind of all day, and if you’re not someone who has a lot of anxiety attacks, probably a fine thing, but if you’re someone who gets those moments where your body goes into that fight or flight state, VeRelief is that’s what it was designed for, but you can use both. That is the benefit of technology is there’s no side effects. You can stack as many as you can and just enhance the effect. I tell people that all the time. Wear your Apollo and do this at the same time.

Carrie: Well, thank you so much for sharing this information with us. I hope it’s valuable to some of our listeners. I know that I talk to all kinds of people all the time who are just looking for different options to help them manage their anxiety. Maybe they’ve tried medication or they’ve tried certain meditations, they’ve tried a variety of stuff, and they just feel like they’re not getting the relief that they’re wanting or they’re needing something, like you said, in the moment right before they go perform or speak in front of people, or even if it’s just a presentation to a few people at work.

If that really makes you nervous and this is something that’s going to help you before those types of situations.  If going into your job makes you anxious, I mean, there’s just so many different applications for this product. We’re going to put our affiliate link in the show notes for everybody and make sure that you can check out the product and take advantage of trying it out and get in the full 60 days. Hopefully you’ll love it. For some reason you don’t, you can contact the staff and they’ll help you troubleshoot with that.

Dr. Hool: And we’ll troubleshoot too. And. If it really, really doesn’t work, we do refunds as well. One thing to note is this is kind of a newer space. There’s not a lot of products like this on the market. There’s definitely a temptation for people to want to go to Amazon or buy some Chinese knockoff that is like an ear clip for 30 bucks. But those things will do nothing. They have no impact on your nervous system, unless you’re someone who’s extremely chronically imbalanced. It might have some effect, but our product is the real deal.

We spent years developing this. We tested everything out there. This thing is by far the most effective out of any other auricular vagal nerve stem you can try. So it’s worth the wait. Definitely worth it. And with that 60-day money-back guarantee, it’s as low risk as possible.

Carrie: Well, thank you so much and we’ll be in touch.

Dr. Hool: Thank you, Carrie. I appreciate the time.

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Christian Faith and OCD is a production of By the Well Counseling. Our show is hosted by me, Carrie Bock, licensed professional counselor in Tennessee. Opinions given by our guests are their own and do not necessarily reflect the views of myself or By the Well Counseling. Until next time, may you be comforted by God’s great love for you.

68. Approaching Insomnia Differently with Martin Reed

Written by Carrie Bock on . Posted in Anxiety, Podcast Episode. No Comments on 68. Approaching Insomnia Differently with Martin Reed

Martin Reed is a certified health education specialist and a clinical sleep health specialist.

  • Martin’s personal insomnia journey and how it led him to learn helpful techniques
  • Regaining his sense of sleepiness
  • Misleading information about sleep
  • Do we really need a certain amount of sleep?
  • Helpful tips to calm a racing mind and sleep better
  • Can we still sleep even when we have difficult thoughts and feelings?
  • Martin Reed’s sleep coaching and online sleep education

Links and Resources:

Marin Reed

More Podcast Episodes

Surrendering Our Insomnia to God

Transcript

Carrie: Hope For Anxiety and OCD. Episode 68. Today on the show. I have an interview with Martin Reed. Who’s going to talk to us about approaching insomnia differently? Martin is an insomnia coach. And has this certification in Clinical Sleep Health. He’s going to provide some really practical advice on the show today. And I have to be honest to say that I really needed this and utilize some of it in pregnancy. I had horrible experiences with restless leg syndrome, and then later it changed. Lots of insomnia and it took me a little while to get into this rhythm, to work through and overcome it. So if you have trouble sleeping, like many people do, you’re really gonna want to tune into this episode. Martin, tell us a little bit about your own struggles with insomnia and how that led you to helping others with their sleep.

Martin: I was always one of these people that never had an issue with sleep. I loved to sleep. If it was advisable, I would have put it on my resume. You know, it was just the IXL that, and so it was something I never really thought about back in, it was, a long time ago, 2000. I think it was, I immigrated from the UK to the US and I was also getting married at the same time. So lots of big life changes. And at that time I experienced some sleep disruption. Never really thought much about it, you know, because everyone has some difficult nights from time to time. And I figured that it was just one of those things and it will get better, but it didn’t, and it was strange.

Because then I started to get a little bit more concerned about it. Not, not like crazy concerned, but this is an emergency, but just more concerned about it. And I started to do things to try and fix the problem, right? Because in life, when we have a problem, we try and fix it. But instead of sleep getting better, it seemed to get even worse. And then this led to more REM. Now, you know, I was starting to get really concerned about what was going on. So like what most of us do when we have issues or problems, we turn stopped to Google and see, see what the solutions are. And to be honest, that wasn’t a lot of very helpful information out there, I think has got a little bit better sense.

But back then, there was a lot of information that wasn’t helpful and it mainly centered ironically on sleep hygiene, which unfortunately is one of these things that people with chronic longer-term insomnia are often told about already know about. And we actually know that it’s not helpful for people with chronic insomnia because it’s more to do with prevention rather than treatment or cure.

You know, it’s a bit like if we get a cavity, we brush our teeth, then it’s not really going to help. But if we brush our teeth before the cavity, it’s helpful, then, you know, and, and I also thought it was a little bit condescending that someone would say, “well, if you have a hot bath or make sure there’s no light in your bedroom, or you set the right temperature in your bedroom, then everything’s going to be okay”. And so I was just really struggling, you know, because there was this problem that I’d never experienced before. 

There was all this information out there that just didn’t seem relevant or helpful. But, tubs, I kept on looking and I came across these techniques, which we now know, which I now know of as, grounded in Cognitive Behavioral Therapy for Insomnia CBTI techniques. And it’s just about changing our behaviors in a way that helps create better conditions for sleep. 

So I found these two specific techniques, that was, don’t spend as much time in bed. Which seemed completely illogical because I wanted to spend more time in bed to try and catch up on sleep and get more sleep. And upon reflection, you realize that more time in bed usually means more time awake and therefore you end up kind of perpetuating this sleep disruption. And another technique was to just get out of bed. If you’re struggling in bed, you’re just spending a lot of time away. So figure figured, you know, all right, thIs sounds different. 

These don’t sound logical at first glance and maybe there’s something to them, you know? So I tried them out and I found them really helpful. I started to regain that sense of sleepiness when I went to bed at night, by going to bed a lot later than I was. And it also just made the nights a little bit more pleasant because I had that option now, instead of just staying in the bedroom, being in bed didn’t feel good. I could just, like, get out of bed and maybe watch some TV or read or just do something to make being awake a bit more pleasant rather than just tossing and turning. So anyway, to cut a long story short, as I found these techniques helpful, I figured these techniques need to be out there more.

There’s not enough support out there for people with chronic insomnia. There’s a lot of misinformation. I ended up just starting off by creating, like a forum, just people, for instance, with insomnia, just to get support. As I found that these techniques were actually really helpful, not just kind of a flash in the pan that helped for a week. And then I was back to square one, but I actually found that they were helpful over the long term.

I figured maybe I can be someone who also shares these techniques. And so there were some people in the forum. I said, “Hey, let’s. I’ve learned about these techniques. If you’re interested, let’s see if they help you too”. And they were helping other people too. So I figured out there must be rid of that. It really is something to this. And so that just kind of led me to where I am today. Over the course of a number of years, I decided that I want to get the word out about these techniques. 

I want to help people coach them through this with evidence-based techniques, not this kind of sleep hygiene stuff. And so that was when I ended up going back to school, I obscured my master’s degree, becoming a health coach, getting certification in Clinical Sleep Health and sending up in Insomnia coach.com, which is my sleep coaching business for people with insomnia. So, it was basically a journey of my own experience. And that’s what led me to where I am today. 

Carrie: What you say, is there some kind of time limit for people? If you, for example, if you’re laying in the bed past. Is it 20 minutes, 30 minutes, then you should probably get up and do something different or try something else?

Martin: It’s a tricky one. Because, if we’re following, kind of the latter of the technique, we usually see people suggesting. If it’s like 20 minutes or 30 minutes of wakefulness then to get out of bed. But sometimes I find that’s not so helpful because it leads us to kind of lying in bed. Has it been 20 minutes? Has it been on my own, 15 minutes? Is it 10 minutes? Maybe I should check the time when we do all these things that ratchet up that brain activity. 

So usually I find it helpful to just be like, what does it feel like to be in bed? If it feels pretty good, you know, you’re calm and relaxed, then maybe we don’t need to get out of bed because that implies that conditions might be right for sleep. So there’s no need to jump out of bed. And that way, when we just use how we feel as a gauge, we might be less inclined to monitor for time or to check the time during the night, which usually isn’t very helpful. 

Carrie: Let’s talk about that. Some more, like, as far as behaviors that you see people with insomnia engaging in. That isn’t helpful. So for getting a good night’s sleep. So one of the things you would say is like clock checking, like what time is it? And then doing that calculation. Okay. Now I’m only going to get six hours of sleep. 

Martin: Exactly. I think, I don’t think we need to be like, really committed to avoidance. Sometimes we’re going to see the time. That’s fine. It’s when we kind of seek out the time. I think that’s when it can be a little bit problematic. I’m still waiting to hear from someone who told me who has chronic insomnia, who told me that checking the time during the night, like actively checking the time through the night, made them feel good and was helpful.

Usually the best outcome is neutral, but most of the time, like you just said, it leads us to think, okay, how much sleep if I go, how long have I been awake? How much time do I have left? Just get all those cogs tony again. And it seems like such a small thing. Just not to check the time during the night.

I have so many clients that tell me that was one of the most helpful things they did just making that change because it’s one less thing for the mind to be concerned with during the night, in terms of other behaviors, we commonly see people with chronic insomnia, completely understandably engaging in, but that kind of backfired on us is like a touched upon just spending too much time in bed or allotting too much time for sleep. And so we might be giving ourself a sleep schedule where we’re going to be in bed. 8 hours, for example, because we want to get eight hours of sleep or I, you know, I’ve had clients that have moved on to spending nine hours in bed, 10 hours in bed, 11 hours in bed, because they’re just so desperate to kind of get more sleep, to create conditions for sleep.

But unfortunately, this backfires on us because. What happens is we usually then go to bed before we’re sleeping enough a sleep. We can go to bed. It’s really easy to confuse fatigue with sleepiness. Fatigue is kind of feeling run down, worn out, exhausted difficulty, concentrating that brain fog, which I’m going to throw it out there. I’m going to guess that 99 to a hundred percent of people with chronic insomnia experience all of the time. And it’s really easy to confuse that with sleepiness and to think, that means it’s time for bed. That sleepiness is just finding it hard to stay awake. And that only occurs when we’ve been awake for long enough.

And when we have a lot of concern about sleep, sometimes we need to be awake for a little bit longer than we used to be in the past to build up enough sleepiness, to kind of overpower all that stuff that’s going on in our mind. So, spending too much time, allowing too much time for sleep, getting out of bed all different times.

You know, according to how we sleep from night to night time, the ironic thing that we see with people with chronic insomnia is often let’s say, you’ve set your alarm for six AM, you fall asleep? Finally at like 5:30 AM. So you get half an hour asleep, human nature. You’re going to want to turn that alarm off and get that sleep because it’s now happening. And it feels great at the time to do that, but unfortunately, it’s a little bit like kicking the can on the road. You know, we might get that bit of extra sleep when we do that, but we kind of setting ourself up for sleep disruption the very next night, because we’ve been sleeping for later in the day. We’re back to, then we’re not going to have as much time awake during the day to build up that sleepiness for the next night. 

Carrie: So naps good or bad, or is it hard to know? Just kind of depends on the person. 

Martin: Think for safety. Naps are always appropriate. You know, if we actually feel like we’re going to fall asleep without warning and we need to drive or operate machinery or something like that, you know, safety trumps everything. But ideally we want to avoid those daytime naps just because they’re going to reduce what we call sleep drive. One way we can imagine sleep drive is like, if we take a balloon and we’re blowing air into a balloon, every puff of air into that balloon is like an hour that we’re awake and we sleep when that balloon bursts.

So when we first wake up in the morning, you know, an hour, every hour of waiting, a furnace blowing air into that balloon blowing air into that balloon. And, and the idea is by the time we go to bed, that balloon is really close to bursting. We get into bed, pop the balloon burst and we sleep. So if we imagine that kind of analogy for naps, our balloon is about half full during the day. Then we nap. We’re kind of letting air out of that balloon. And then we got the rest of the day. We ended up going to bed but the balloon is still a little bit floppy, you know, not really close to bursting. So it’s one of these things that, and that might feel good at the time during the day, but then we’re kind of setting ourselves up for some potential for sleep disruption the following night.

Carrie: That makes a lot of sense, actually. It really does.

Martin: Another reason why it can be helpful to just avoid those daytime naps is it can also be just another area of concern because people with chronic insomnia. Often try to nap during the day because they’re chasing sleep. We’re so desperate for sleep to happen, whereas people without chronic insomnia they’ll nap during the day, because they’re sleepy, they’re finding it hard to stay awake.

So a lot of the time, especially my experience, I see clients. They try to nap during the day, but then they can’t nap. So that generates even more concern because then they’re like, oh my goodness, I’m really struggling to sleep at night. And I can’t even sleep during the day when I try to nap. So just by removing naps from the equation, we’re eliminating that potential source of more concern. And we’re also banking all that daytime sleep drive to help with sleep at night. 

Carrie: There’s so much of this, that’s connected to stress. So it’s like I’m stressed and then I can’t sleep. But now, because I can’t sleep, I’m stressed about not sleeping. And that really leads into the thought process that people get into with insomnia. So talk with us about that. Some of the common thinking errors that people have.

Martin: Absolutely. My thinking on thinking, my thinking on thoughts has definitely evolved over the last few years when I first learned more about these CBT I techniques. The traditional way of thinking that is the, we have, like dysfunctional thoughts, thoughts that are inaccurate or incorrect, and that we should perhaps evaluate them, criticize them, or try and change them into more accurate, or more positive thoughts.

My thinking now is that. We don’t need to really do any of that because thoughts are thoughts. Sometimes thoughts are true and they’re accurate, sometimes they’re not. So, but we don’t necessarily need to get into an argument with our mind because these are thoughts. Thoughts can make us feel good. Thoughts can feel unpleasant, but they’re still thoughts. And we can still control our actions and our behaviors, regardless of what the mind tells us. Even though sometimes that, that prompting from the mind. Can lead to us responding. Behaviourally almost instantaneously and make us believe that thoughts control our actions with some practice.

We can help to kind of decouple our actions from our thoughts. So I don’t know if they asked you a question, but generally now I take the approach that there’s no real dysfunctional thoughts, per say. There are just thoughts and that we can always work with our thoughts in a way that separates our actions from our thoughts so that we can still do things that create good conditions for sleep. And we can still do things that help us move toward the kind of life we want to live, even with all those thoughts going on in our minds. 

Carrie: I think really learning to become an observer of your thoughts and not having to get sucked into every single one that you’re having or believe that it’s somehow. Character reflection on you or that you have to act on it kind of what you were saying. It’s like, you can have a thought. And certainly, we have thoughts all the time that we don’t act on.

Sometimes we have thoughts that we should act on like, I should exercise. And we don’t. And then other times, you know, we have thoughts and we’re like, that was out of left field. That’s not really who I am or what I lined with. So do we have a misperception though, sometimes about sleep just from what we’re told with doctors and you know, I have to get my eight hours and you know, I’ve just heard conflicting things on that. I’ve heard some people say, you know, well, no, you don’t necessarily have to get eight hours. It just depends on your age and your own kind of individual makeup. Some people need more sleep than others. Any thoughts on that?

Martin: Definitely. You know there’s a lot of misleading information out there about sleep. A lot of it does focus on sleep duration. So many of us can have the belief that we need to get eight hours of sleep, or we need to get a certain amount of sleep. The thing about that is anytime we read information about, we should be getting a certain amount of sleep, it’s always just based on averages. It’s a bit like saying everyone should be five foot, 10 inches tall, just because that’s the average height. I don’t know if that is, but I’m just guessing here, but you know, all I’m just getting at is it’s just one of these things that’s based on averages.

So there are always going to be happy, healthy people that exist outside of these averages. Just like with our height, we can’t control sleep duration. We can help, we can use our behaviors in a way that creates good conditions for sleep, but in terms of how much sleep we’re going to get, we have no control over that. And often we get most caught up in the struggle when we do try and control that a lot of the clients I work with, they find the best, just such a relief to know that they don’t need to aim for eight hours or seven hours of sleep. 

You know, they just need to allot an appropriate amount of time for sleep. You know, give themselves the opportunity to get sleep. And the body is always going to generate at the very least the band and minimum amount of sleep we need. No matter what, as long as we’re giving it the opportunity to generate sleep, we never lose the ability to sleep. So it’s really about just trying to not control things that we cannot control and sleep duration is one of the things that we can’t control.

Unfortunately.

Carrie: That’s an interesting concept that I’ve never really thought about or pondered. It’s like, I don’t have control over what my body does, how long it stays asleep and whether or not, you know, I’m able to wake up rested. It’s like I have to provide the opportunity, but then my body has to kick in and, and sleep with it. Interesting. 

Martin: Exactly. One thing about, well, just to add onto that one thing that we often see when we read these articles about sleep duration. They’re really aimed primarily at people who aren’t getting enough sleep because they’re kind of burning the candle at both ends. They’ve got a busy home life. They’ve got a busy work life, so they’re just not giving themselves the opportunity to sleep. We’ve got, I think a lot of this advice or information about try and get seven to nine hours of sleep or whatever it is people are saying these days is, comes from a good place where it’s aimed at people who are only giving themselves four hours to sleep because they’re not prioritizing sleep. 

Because they’re too busy, doing everything else, people with chronic insomnia at the opposite, they are prioritizing sleep. They are giving themselves plenty of time for sleep. So I think the messaging comes from a good place, but it’s just aimed at a different audience. Unfortunately, the only people that are really paying attention to all this information are the people with chronic insomnia who it doesn’t apply to quite so much.

Carrie: So I would imagine there’s a lot of people listening to this podcast who deal with Anxiety and OCD, and they’re saying, okay, the problem I have, I feel maybe physically tired, like I’m ready to go to bed, but then it’s like, my mind is on overdrive and it wants to think about all the things I have to do tomorrow, or what happened today or things that are bothering me that I can’t control. Are there any helpful tips for people who just have a hard time shutting their mind off, who want to go to sleep? 

Martin: Definitely. Well, I think first and foremost is making sure we only go to bed when we’re truly sleepy enough for sleep. I’m talking about finding it hard to stay awake. Because, our sleep drive system will always overpower like that arousal system or the mental chatter once it’s strong enough, no matter what, without fail, it might take a night or two, but sleep will always happen, that sleep trifle always be strong enough at some point.

So we can always get ourselves one step ahead by making sure we only go to bed when there’s that strong sense of sleepiness. And then in terms of. All that mental chatter, all the mental gymnastics, really all that is, it’s our brain looking out for us. You know, it’s not a brain trying to cause us problems. It’s like our brain is being a really overly enthusiastic friend. Who’s trying so hard to help us out. It’s just kind of getting in the way. So I think just recognizing that, you know, this isn’t an adversarial relationship. It’s just our brain trying too hard to help us out. That can be helpful. And just recognizing that that’s what our brain does.

Our brain’s number one priority is to look out for us. Often we get most caught up in all this mental stuff. When we quiet, understandably, try to fight them or avoid these thoughts, these feelings, these emotions, because they’re unpleasant. So naturally we don’t want to experience them. But unfortunately that’s when we usually get most caught up in the struggle, trying to fight them, trying to suppress them.

It’s not usually helpful over the long-term short-term. Sometimes we can, like push feelings and thoughts away. They always come back and then when they come back, they tend to be stronger. It’s a bit like pushing a beach ball down under the water, you know, it’s just going to push back harder and harder. The more we put, try and push it away. Sometimes I think it’s just helpful to recognize, like, this is my mind looking out for me, I’m feeling, identifying and acknowledging everything it is feeling. I’m feeling this is my anxiety coming back. This is my frustration and my anger, whatever it is, you’re feeling. Just identifying it, labeling it, recognizing it, not trying to fight it or push it away can be really helpful. 

Just the fact that we’re thinking certain things or our mind is racing. Doesn’t mean we’re not going to be able to sleep. We can still sleep when we have difficult thoughts and difficult feelings and difficult emotions, but it becomes a lot more difficult for that to happen when we try and get engaged in controlling them and pushing them away or trying to avoid them, trying to fight them. And I think, you know, as a last resort, kind of what I touched upon. Aaliyah was if you’re just spending a lot of time in bed and it really just does not feel good to be in bed. It might be helpful to just get out of bed and just do something a bit more pleasant until conditions feel a bit better for sleep.

Carrie: Talk with us about what the CBT I program that you have looks like, is it over a course of a certain number of weeks or a certain number of lessons that are involved in it? What does that look like? 

Martin: My course is kind of grounded in many of these techniques that are taken from CBTI. It’s not CB type itself because technically that is a therapy. And I’m not a therapist. So I just coach people on these techniques. There’s kind of, I take what I personally found helpful from this collection of techniques and what other clients have found helpful along with just some other things that are more grounded, maybe more towards the act model, acceptance and commitment therapy. 

So, it kind of combines them, a little bit of cherry picking. And my online course runs for eight weeks and it’s conducted online. Clients can fill out sleep journal. And check in with me as they progress. And the way it’s currently structured is the first week is just about education, you know, sleep education, because like we touched upon, there’s a lot of confusing and maybe misleading information out there about sleep, how much sleep we need, what a normal night of sleep is like. And then as the weeks progress, we start to introduce these behavioral changes that aren’t intended to make sleep happen or to control sleep, but rather to help address any behaviors we might have implemented to try and improve our sleep that are kind of backfiring on us and to just change our behaviors in a way that creates good conditions for sleep.

So we kind of come up with a sleep schedule and earliest possible bedtime. Consistent with our bedtime in the morning, we talk about what to do during the night. If we’re awake, like you just touched upon all the mind games going on. What if we wake up in the middle of the night, we can’t fall back to sleep. What do we do? And we also just go through ways that we can explore our thinking, you know, not to control our thoughts, but just to maybe change our relationship with our thoughts where maybe we’re less influenced. By our thoughts and feelings, we’re less inclined to try and control them. And we kind of get independence back over our behaviors, but it’s the, our thoughts. Aren’t kind of dictatorial and control all of our actions. They’re the kind of core educational components, but really it’s kind of, it’s quite different for every client I work with because it’s very customized in terms of the specific challenges that each client is facing. We work together to focus on where the client feels the priority should be in terms of where they’re struggling and what their challenges.

But, so it’s, so it’s educational based and the changes, the components are introduced gradually over a course of eight weeks, which I also find is helpful. So it’s not. We should do this, this, this, this, this, this, this, this, this go, you know, there’s completely overwhelming. We just say, okay, first week, let’s just do focus on some more education the second week.

Let’s see if we can change the sleep schedule a little bit, the third and fourth week. Maybe let’s practice getting out of bed if being in bed doesn’t feel good. You know, so it’s all gradual so we can learn a new technique, become a little bit more comfortable, confident with it before we then add most stuff.

Carrie: So as we’re winding down at the end of every podcast, I like to ask our guests to share a story of hope, which is a time in which you received hope from God or another person.

Martin: You know, I think it would really go back to my own experience when I was first struggling with insomnia. And I learned about techniques that, once the hygienic pastes that were a little bit different and that in itself. Just gave me hope because when I was just finding the sleep hygiene stuff out there, that wasn’t helpful to finding these new techniques gave me hope and it gave me the motivation to give them a try. And I think that kind of inspired me to use those techniques, to offer hope to other people as well. You know, it’s this kind of knock on effect, first of all, through the forum and then through how that’s expanded. You know, through my own podcast as well. And just working with clients, seeing that transformation, sharing their transformation, just spreading that hope out there to others as well.

Carrie: That’s awesome. Thank you so much for coming on and sharing your wisdom with us about using these techniques that are very practical for overcoming insomnia. 

Martin: Absolutely. It’s been a pleasure to me? 

Carrie: We would love for you to help us get the word out about the podcast. I know, you know, at least one person in your life right now, who is having difficulty sleeping, feel free to forward the link to this episode to them and let them check it out.

You can always rate and review us on iTunes, and that helps our show as well. Thank you so much for listening.

Hope for Anxiety and OCD is a production of, By the Well Counseling. Our show is hosted by me, Carrie Bock. Licensed professional counselor in Tennessee, opinions given by our guests are their own and do not necessarily reflect the views of myself or By the Well Counseling. Our original music is by Brandon Mangrum. Until next time. My you be comforted by God’s great love for you.

54. Medications for Anxiety and OCD with Jennifer McGlothin, psyNP

Written by Carrie Bock on . Posted in Anxiety, Podcast Episode. No Comments on 54. Medications for Anxiety and OCD with Jennifer McGlothin, psyNP

Jennifer McGlothin, a psychiatric nurse practitioner and I have an informative conversation on medications for anxiety and OCD 

  • What is the role of a psychiatric nurse practitioner? Can they prescribe medication for mental health? Are they allowed to diagnose?
  • What patients should know when they are starting a new medication or switching medication.
  • How long does it take for psychiatric medication to work?
  • Managing mental health medications
  • The Importance of communication between patient and health professional

Related links and resources:

Jennifer McGlothin, psyNP


If you enjoy the podcast and want to support what we’re doing, or if you’re looking for self-help materials to assist you on your journey of managing your anxiety and OCD in healthier ways. Audio teachings, relaxation exercises, and my book on how to find a therapist are provided for self-help via monthly subscription, go to www.patreon.com/hopeforanxietyandocdSubscribe to our newsletter: https://hopeforanxietyandocd.com/

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Transcript

Welcome to Hope for Anxiety and OCD Episode 54. I have been wanting for a little while to talk about medication as an option for anxiety and OCD. So that is what we are going to do today. I know that a lot of people have questions about whether or not they should get on medication. Whether they should look at that as an option or whether they should stay away from it.

So hopefully this episode will give you a little bit more information to help you make an informed decision about whether or not you want to pursue that as an option and maybe dispel some myths that people have about medication for mental health conditions. So today on the show I have with me Jennifer McGlothin, who is a Psychiatric Nurse Practitioner at Safe Harbor in Murfreesboro, Tennessee.

Carrie: Welcome to the show. 

Jennifer: Thank you so much for inviting me. 

Carrie: Tell us a little bit about your background and what you do on a day-to-day basis. 

Jennifer: So I have been doing psychiatry since around 2009. I graduated from Vanderbilt with my Masters in Psychiatric Nursing, and I’ve always been in a clinic setting, primarily community mental health until August of 2020, which is when my friend and I opened our own private practice. As far as psychiatric nurse practitioners in the medical world, we’re primary utilize is as medication management, we have the ability to do therapy. But that’s not really where we sort of fall on a day-to-day basis. When I was in a clinic that was my all day, every day was just seeing people back to back doing medication management.

And so August 2020, sort of out of necessity and God’s guidance, my friend and I opened our own private practice with the idea of being able to start to treat patients the way that we knew it needed to happen and to be able to provide a safe setting that they could come in and tell their stories and be heard and get the treatment that they needed.

Now day-to-day is a little bit different because we’re an owner of that, but we still see patients every day, but then that’s just sort of peppered in with administrative stuff of running the business. It sort of depends on the day whether we have new patients or just return patients, some days are telehealth some days are in the office, just kind of, depending on what the patient’s preference is at this point, especially since COVID has kind of changed the face of psychiatry telehealth is utilized a lot more. But our primary role and expertise, I would say probably, is medication management. 

Carrie: Okay and I think some people get very confused as well by the terms psychologist, psychiatrist, licensed counselor. And so it’s important for people, sometimes people will contact me and ask me about medication. I’m like, hey, I’m not a medical doctor, that’s not what I do. I don’t have that training. So typically the psychologist is someone with a Ph.D., but they don’t prescribe medication, and psychiatrists or psychiatric nurse practitioners are medication providers. So this is for people who are kind of wondering about some of those titles or maybe confused. I know some of the terms sound similar and so it’s easy to get that confusion there. So I know that even though I’m a therapist, clients will certainly talk with me about medication. Should I get on medication? Should I not? Maybe they’ve had experiences with medication in the past. Maybe it was helpful, not helpful, so forth. And I think it’s understandable. Sometimes people look at anxiety as a physical condition. Some people look at it as a mental health condition and from what you’re seeing, sometimes people may pursue that medication route first.

Whereas others for anxiety, whereas other people may pursue a therapeutic route. First, I would imagine that you have some people that come in there that are being seen for anxiety, but then you start to ask more questions and identify that what they’re really dealing with is OCD. Can you tell us about that?

Jennifer: It depends. It really runs the gamut, whether they, when they come in to see us. Sometimes, they’re treatment-naive, which means that they’ve never seen a mental health professional before, or sometimes they’ve been doing mental health for 20 years. And once you start asking questions, we are asking questions about all disorders really. So we’re asking about depression. We’re asking about bipolar disorder. We’re asking about anger. We’re talking about sleep and appetite. We’re really looking for, what could the potential diagnoses be? Sometimes OCD will come out as a potential diagnosis because there are a lot of aspects of OCD that people don’t necessarily associate with it because it’s not as well known.

So typically when people think about OCD, they may think about the money who washes their hands a lot, or they may think about somebody who puts things in a certain order. Do things by color. One of probably the lesser-known forms would be really common, intrusive thought that they’re going to do something that’s completely outside of their personality and fear that they’re going to do it. So the fear that I’m going to drive my car off the road, even though there’s no desire to do that, they would never do that because they don’t want to hurt themselves. They don’t want to hurt anyone else. But the idea pops into their head that like I’m might do that. Or an idea of maybe I did something that I don’t know about is something I’ll hear a lot. I think that I turned off the stove, but maybe I didn’t actually do it. What if I thought that I said this to my child actually didn’t it, it will be this sort of questioning of themselves. The more that we’ll talk about that it will really kind of move more into the OCD realm. 

What that does is it will sort of just change your treatment perspective a little bit, as far as what you’re going to do in medicine and therapy, then it becomes talking about really what OCD can look like. And it makes sense that people who are in a high state of whether it’s anxiety or OCD, they’re dealing with some distress and may have hesitancy about it taking medication. 

Carrie: What do you tell your patients who are concerned about starting a new medication or switching medication? Because the last one wasn’t helpful for them.

Jennifer: The very first thing that’s most important for any patient is that, and it’s not always conveyed this way, but I think this is super important for anyone to know is that it’s always their choice. So no matter what the provider says, it’s ultimately their choice at the end of the day. Because when you leave that room, the patient is the one who’s taking the medicine and the patient’s the one who’s going home with it. When you’re coming to see me, for instance, I’m giving you my opinion about what I think is best, but ultimately it’s your choice.

I think a lot of times in medical situations, people can feel kind of powerless and they feel like they have to listen to exactly what the provider says. And sometimes it is good to do that, but if you don’t feel comfortable with the situation, then you don’t have to go along with that. So I think the first important thing is to know it’s always in your court and then also be really educated on what is the purpose of the medicine and that the idea is to make things better. If the medicine you’re taking now is not making things better then we probably need to make a change, really talking about what’s the goal. What do you want? What would make things feel more manageable to you? What would that look like? Then figuring out how do we get there? When they’re anxious about that, you have to really break it down into, we’re just wanting to improve things. This is why this is how, and sometimes I think that education and knowing that ultimately they have the final say is really helpful for people.

Carrie: This is really huge. I think that we don’t emphasize enough, like empowering people to make the health choices that are best for them. Yes. There are experts who can say, hey, these are the medications that are commonly prescribed. Here are the side effects. We believe that in prescribing this medication, the benefits for you are going to outweigh the side effects, but ultimately you have to weigh that option and everything is a potential risk. Empowering people is so key in that. And I liked what you said about it, just ultimately it being your choice. 

Sometimes I’ll have people in therapy who want to try therapy first before they try medication. I always tell people I’ll work with, whether you’re on medication or not, it’s not really a big deal for me, but it’s interesting because sometimes we’ll circle back around to that medication conversation after they’ve been in therapy for six months or so. And they’re not seeing the progress that they’d like to see, then I’d say, okay, can we circle back around to this wagon? And can we evaluate this as an option? Will you go talk with someone and just see what your options are? What they think might be helpful for you. And I know that oftentimes people are started on a lower dose of medication, just to make sure that their system is going to handle it well. 

Jennifer: One of the things that I’ll talk about when somebody comes in and they’ve never been medicated before, or they’re just coming in because they’re not really sure what needs to happen. And it’s not a very clear-cut case of like, we absolutely need to do something today. Sometimes when I ask the person, okay, do you think you need medicine? Do you feel like this is really impairing your function? And sometimes they’ll say, yeah, I think so. When it’s like, okay, well, I’m willing to give that a try, and sometimes they’ll say, I mean, I think I could do therapy for a little while first and like, I’m okay with that too. So let’s go that route and that kind of, once again goes back to making the decision, but I want to know what’s their opinion. How do they feel like their functioning is affected by the symptoms that they’re experiencing, being able to hear that is really helpful sometimes. And then, when you’re in school, one of the slogans that you’re taught about medicine to start is to start low and go slow. So that is basically just trying to minimize the amount of side effects that someone experiences. Sometimes that, unfortunately, means that they’re not gonna see the efficacy as early as you would hope.

In other words, they’re not going to stay, their symptoms decrease as fast as you would like to stay, because symptoms are too high to match the low dose that they’ve been started on. But then you get into a situation where if you start them on a higher dose, they’re going to have a lot of stomachs upset or they’re going to be too sleepy and they’re not going to be able to get up the next day and then that side effect is not going to be tolerable. So then they’re going to stop the medicine anyway. So once again, it goes back to that balance of trying to, I use a seesaw a lot as like a, not a visual, but to kind of explain that we’re trying to balance the seesaw. It goes back to that idea of trying to balance that risk-benefit, balance that out.

And I think that piece is another thing that’s super important for people to understand is what’s the timeframe that I’m going to start to see a difference, because if they’re expecting that they’re going to see a difference in a week, but the reality is four to six weeks. And they’re not told that it’s going to be hard for them to maybe stick with the medicine. And so it’s really important for people to know what we are looking at? What’s the timeframe? When should we start to see a difference? Are we going to see a difference in this dose? If symptoms are really high right now, and obviously not all of that, a hundred percent predictable, but you can give them an idea of what you would maybe hope to see, kind of give them a little bit of a window in.

Carrie: Those are some great points that you made in terms of having to increase dosages at times because people aren’t at a therapeutic dose. Sometimes people end up dropping out and stop taking the medication without talking to their provider. That’s one thing that just drives me a little bit bad. I’m like, no, if you’re not happy or you don’t feel like you’re getting what you need, you go back to that person and you explain, hey, I’m not seeing the results I’m wanting, or I’m having these side effects or there are always different things that can be done or like you just said, they may tell you, okay, well, we’re going to increase your dosage because it doesn’t look like you’re at the therapeutic level or you need to stay on it for sometimes four to six weeks to see the full results from it. I think sometimes people go into the doctor’s office and they’re not always hearing or receiving all the information that they need because they’re distressed. Right. 

And so it’s hard to remember everything that was said and the guidance that was given. So if I could tell, make any recommendations to people it’s please don’t stop your medication. Please stick with it, call your provider, talk with them because some of these medications, it’s really not good for you to stop suddenly.

Jennifer: I also, unfortunately, think that the education piece for patients is not always there. Sometimes they’re not always getting everything they need to get as far as what are the side effects? How long should I wait? Like it’s more just, here’s the prescription first Alexa, 20 milligrams, I’ll see you in two months and that is no information whatsoever. And that is completely on us as a provider. And that drives me nuts because it’s like, it’s so important to me, for my patients to know why they’re taking, why they’re taking it, what it does because I want them to be educated about it because they’re part of the treatment team.

Carrie: It was important for people not to see, I think, any medication really as a miracle cure. And I think sometimes people go into taking psychiatric medication, whether it’s for anxiety, OCD, depression, or something else. And they think, okay, well, I’m just going to take this medicine. It’s going to solve all my problems and similar to, if you put somebody on a blood pressure medication for high blood pressure, you wouldn’t just say, well, just take this medication you want also for them to make some lifestyle changes that would support what that medication is working on.So talk with us a little bit about that too. 

Jennifer: I use diabetes as an example. A lot of the time I will say, this is very similar. So like someone with diabetes, they take their insulin, but then they also check their blood sugar and they exercise and they have to watch what they eat. It’s a combination. And so that’s when we talk about that. The best results come from a combination of medicine and therapy and that medicine is just one tool in the toolbox. It is not the end. All be all, and medicine can help you cope, but it doesn’t teach you how to. And super important for people to know that you have to learn the coping skills medicine can help lower your anxiety, but life circumstances, there’s gonna be times that anxiety is going to spike and you need to know what to do when that happens and medicine doesn’t teach you that. So that’s where that other piece of the puzzle comes in. Whether that’s a therapist you’re seeing your past, or you’re seeing you’re doing a workbook at home, whatever it is that you’re doing something to learn what to do in those other moments, because it’s not a matter of if it’s going to happen. It’s a matter of when. And so we have to plan ahead for that. 

Carrie: What different types of medication would you say are commonly prescribed for anxiety or OCD? 

Jennifer: For both of those really it’s antidepressant and anti-depressants are first-line treatment for anxiety. And so I’ll have a lot of people come in and there may be already on a medicine that came from primary care and they’ll say, well, I have anxiety and they put me on this antidepressant and I’ll say, well, that’s actually appropriate because the antidepressants are first-line treatment for anxiety. The five medicines that are FDA approved for OCD are actually all antidepressants. The most common medicine probably used in OCD specifically is probably Prozac. There are four others after that, that are sort of used in varying order.

There are some medicines for anxiety that can just be used as needed that we like in our practice. We use an antihistamine sometimes that’s as needed. There are actually a couple of blood pressure medicines that we use as needed for anxiety. Providers will use benzodiazepine for anxiety that is not favored where we are, because those are very addictive medicines and they actually make anxiety worse in the long run and they call short and long-term memory loss.

There’s links to dementia. It will fix it quickly in the moment when you’re having an anxiety bite, but long-term, it’s going to make things worse for you. And so that’s something that we in our practice avoid because it’s not fixing the problem. So when you’re looking at an antidepressant for anxiety, what that’s actually doing is it’s adjusting the brain chemistry. All of the ones. When we look at anxiety and OCD, because of course the OCD is an anxiety disorder that all targets serotonin in some way or another. They’re adjusting the levels of serotonin in the brain. So we’re actually changing the brain chemistry, ideally back to where it needs to be. So kind of a way I sort of describe that to someone as like the thermostat is stuck and we’re trying to race that we’re trying to sort of teach the brain how to relearn the patterns for which chemicals need to be there and what capacity. 

Another important thing I think if it’s just anxiety and especially if someone’s in therapy, is that medicine doesn’t necessarily have to be forever. It’s something that until you can build the coping skills to learn how to manage most situations. And we have sort of put unquote, retrain the brain for what chemicals need to be there and what capacity for long enough, then you can try to come off of the medicine potential and do it on your own. OCD is not necessarily doesn’t fall into that category so much. That’s more of something that’s managed, like someone who has diabetes, that’s just managed throughout the year. But for some disorders, our goal was to try to fix it at the beginning. So it’s not a lifelong thing.

And I think that’s a common misconception too sometimes is that you want to put me on medicine and just keep me on it forever. Not necessarily, we could potentially fix this problem now so that it’s not a problem for it. And it’s dependent on different things as far as what episode they’re in and how long they’ve been on meds and there’s varying factors. But I think a lot of people don’t know that that’s a possibility. 

Carrie: I think that’s a really great point that you bring up. One of the common concerns that people have is whether I’m going to become addicted to this medication somehow dependent on it and I’m not ever going to be able to come off of it. So from what you were just saying, these first line of defense medications, the anti-depressant. People aren’t going to become addicted or dependent on those, right? 

Jennifer: Not at all. No, they do not have any addictive properties whatsoever. I think sometimes what people might get confused about would be to say that if you forget to take your medicine one day, you might feel kind of bad. Like you might have a headache or you might have a stomach ache, but that is just simply your body reacting to not having something that it had every single day, but that’s not a quote unquote withdrawal effect. There’s a difference in that.

You have to be able to, to know that like, if you come off of these medicines and anti-depressant specifically, you’re not going to go into a physical withdrawal. There are some that are more difficult to come off and others, but if your provider knows how to appropriately taper you down, it minimizes what we call discontinuation side effects. Just knowing how to do that is important. And obviously the provider communicating how to get off of it is important.

Carrie: Right? So that people can do that safely and effectively. 

Jennifer: If you just stop your medicine suddenly you are probably going to have side effects because you’re going from a hundred percent to zero. All of a sudden your body is probably going to react very negatively to that.

Carrie: What should people look for in terms of choosing a psychiatrist or a psychiatric nurse practitioner? 

Jennifer: The ultimate goal is somebody they feel comfortable with is important. I think to have the ability to have an open dialogue, to express concerns about your medicine at our clinic. Like we are a team and it’s a delicate balance to figure out what the correct path is. And if my patient feels like they can’t tell me that their medicine’s not working or that they’re having a side effect, or they feel like I’m going to get upset about that. It’s the relationship that needs a little bit of work because that’s not what we’re there for. Like if someone comes back and they tell me they stopped their medicine, sometimes they’ll say, they’ll come in and they’ll say, you’re going to be so upset with me. I just stopped my medicine over the weekend. And it’s like, I’m not upset with it. That was your choice. I’m sure it wasn’t probably didn’t feel very good.

So let’s just figure out what we’re going to do next and be able to have that open conversation without judgment and figure out what the best path is. I think I hear a lot of times stories where patients feel like they’re unheard and they just keep taking meds when they feel they’re not working for whatever reason, that’s not a good situation either. I think it’s also important for somebody to have humility because I’m not too proud to break out my books and look something up or to call somebody or to figure out. Because you just can’t know everything. You have to know what your limits are and you have to be willing to research something or to know when it’s time for you to call in somebody else. And if you have a provider who doesn’t do that, I think that’s hard for you, maybe to build a relationship sometimes. 

Carrie: I think what you’re saying is really true of any medical professional that you work with. You want to feel heard, you want to feel understood. You want to feel like, okay, this person has a plan. They’re offering me some guidance and not just guidance, but really some education on, instead of just here, take this medicine. Really providing some good education on the medication, why they think that would be a good medication for you and with the symptoms that you’re dealing with, what the potential for side effects are when they might see those wear off, so forth and so on. I think that it’s huge to understand that we have to be our own best advocate when we’re going into these situations, because we have to be able to communicate what’s going on in our own body. And sometimes people have a hard time with that. I think really communicating what has been going on with them

Jennifer: Because it makes it difficult. Sometimes if the patient is not telling everything because they don’t feel comfortable for whatever reason, then as a provider, if we don’t know the whole story, then we can’t adequately treat. I think a lot of times we don’t maybe get the whole story because of fear of judgment or shame or whatever. But I know in our practice, that’s not our job. Our job is not to judge or to guilt someone or to shame them. Our job is to figure out, okay, how do we move forward? How do we get back? Let’s figure out what our best plan is, but you can’t do that. If you’re not comfortable enough to share what’s going on, really got to find somebody that you can build that relationship with.

Carrie: Awesome. So as we’re getting towards the end of our podcast, I like to ask our guests to share a story of hope, which is a time in which you received hope from God or another person. 

Jennifer: I think for me, probably one of the most hopeful things was sort of born out of something really traumatic in 2009. 10 days after I got married, I had a very traumatic car accident and we spent our first month of married life in the hospital. And I was in a wheelchair for like three, nine specific three months until I could walk again. And just with the amount of prayers and people coming by and my sweet husband’s help driving me back and forth to the doctor, changing stuff at our house, like going to work and then coming back and picking me up and taking me to physical therapy.

And I was able to walk a month earlier and basically made what would be considered pretty much a full recovery. Over 10 years later, no real complications and have been able to sometimes use that story for people who have had something really traumatic physically happen to them. And they’re in that moment of why, what am I going to do? This is terrible and being able to say things like, listen, you can come out the other side of this, like I know right now it does not feel like that, but if you put your faith in Him, you can come out the other side of this and being able to use that sometimes in my practice. 

Carrie: That is really encouraging and hopeful because when you’re in that, the middle of that situation going okay, what am I going to be able to walk? When am I going to be able to do things for myself?

Jennifer: Normal stuff. Yeah. 

Carrie: That must’ve been a very hard situation. Thank you so much for coming on and sharing your wisdom about medication. We’re going to put the information in the show notes for a safe Harbor in Murphysboro, and they also have telehealth appointments. So if you’re in Tennessee or in the area at all and are looking for a new provider, now they know a little bit more about you.

Jennifer: Yes, we are accepting new patients. So give us a call. 

Carrie: Awesome. 

Jennifer: Thank you so much for having me. 

Carrie: You’re welcome. 

———

I hope that you found this interview valuable and helpful. I wanted to give you a quick update on our subscription service for the podcast. There have been just so many struggles and challenges as I’ve sought to do this in our original. I saw that we were going to be able to have a good monthly subscription service on the website, buy me a coffee that I had been using for people to give to the show who wanted to give and what I realized as I got further into the functionality. That I wasn’t able to share all of the audio files and different things that I wanted to be able to do on that website. So I’ve actually created a Patrion page that we’ll put in the show notes for Hope for Anxiety and OCD. If you’re not familiar with Patrion, it’s a website for podcasters and other creators to go on.

And it gives the opportunity for people to be able to support what you’re doing with a monthly gift that we have a smaller, monthly amount that you can give. If you just want to help support our editing efforts and help pay for our assistant to do social media, reach out to guests and so forth. If you’re looking for a little bit more self-help materials, I created a higher tier on Patrion for those of you who are listening to the show, but just feel like you want more content and more information. We’re going to have monthly question and answer times. I’m sharing some thought hush audio on there for dealing with difficult thoughts, whether you have anxiety or OCD, just very practical strategies, audio that you can listen to you exercises that you can go back in and practice over and over and over again until you feel like you become better at managing the anxiety and OCD that you’re experiencing.

So that’s something that’s of interest to you. You certainly can hop on for a month or two, try it out if you don’t like it, and you can cancel it at any time. If you do happen to hop on and try it out, I would love to hear what you think. And if some of those things are helpful and as well as if there’s any ways that we can make improvements to that subscription service, because I definitely want it to be of value to you. We’ll leave that link in the show notes, if you’re interested and thank you so much for listening.

Hope for Anxiety and OCD is a production of by the local counseling in Smyrna, Tennessee. Our original music is by Brandon Mangrum. Until next time may you be comforted by God’s great love for you.

45. Improving Nutrition to Help Anxiety with Dr. Katie Thomson Aitken, ND

Written by Carrie Bock on . Posted in Anxiety, Podcast Episode. No Comments on 45. Improving Nutrition to Help Anxiety with Dr. Katie Thomson Aitken, ND

We are privileged to have our first ever Canadian guest on the podcast, Dr. Katie Thomson Aitken.  Dr. Katie is a licensed naturopathic doctor who enjoys helping people with all kinds of health goals achieve positive changes in their health and in their life.  She also has a passion for mental health, the management of stress and anxiety, and helping individuals connect with their higher purpose.

  • What are the benefits of seeing a naturopathic doctor?
  • Is naturopathy an alternative medicine?
  • Can naturopathy be used alongside other medical and therapeutic techniques? 
  • The 5 Pillars of Mental Wellness
  • The role of neurotransmitters in anxiety
  • Nutrition-related concerns of patients with anxiety and steps to take to help improve nutrition. 
  • Dr. Katie’s book: Create Calm.

Resources and Links

 Dr. Katie Thomson Aitken, ND
Book: Create Calm

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Transcript of Episode 45

Welcome to Hope for Anxiety and OCD Episode 45. If you’ve been following the show, we talk about all kinds of things related to not just the mental health aspects of anxiety but also our physical health. When our physical health is working good, it combines well and helps our mental health and both of those things need to be functioning properly in order for us to get to a better state of overall health.

Carrie: So today on the show we are talking with Dr. Katie Thompson Aiken, who is a naturopathic doctor. This is going to be an interesting episode for me as well since I don’t know that much about naturopathy and that pathway. I’m probably going to ask some questions that some of you might have as well, and we’ll both be learning along together. So thank you so much for being here. 

Dr. Katie: Thank you so much for having me. It’s always a pleasure to talk about anxiety and the mind-body connection.

Carrie: And a random fact, I think you are the first Canadian that I’ve had on the podcast. And I know that we have listeners from all over the world, so it’s good to have people outside of America on every once in a while. I think this adds to our diversity. 

Dr. Katie: That’s wonderful. It’s my absolute pleasure to be here. 

Carrie: Let’s talk a little bit about how seeing a naturopathic doctor benefits people in a little bit different way than seeing a doctor that follows traditional Western medicine. 

Dr. Katie: That’s a great question. I think we will start talking about naturopathic medicine. A lot of people think of it as an alternative medicine, but I like to use the word complimentary. So what I do works alongside some of the traditional care choices that someone might have when they’re looking for support with their health concerns, whether that’s anxiety or for something. In a traditional model.

If you’re experiencing anxiety, you might be offered medication. You might be offered therapy, cognitive behavioral therapy, or group therapy and sometimes that’s it. But we know that there are a lot of things, lifestyle wise, that can be supportive of anxiety. There’s also a lot of conditions in the body: hormonal imbalances and nutritional deficiencies that can contribute to anxiety. When you see a naturopathic doctor, one of the big differences is that naturopathic medicine treats the whole person rather than looking at just one piece of someone’s health, say the anxiety.

When I see a patient and when my colleagues that are naturopathic doctors treat someone, we are asking questions about all systems of the body and what’s going on with your hormonal health. How is your digestion? Do you have cardiovascular risk factors like high blood pressure? And piecing those all together to come up with a comprehensive care plan. We’re also asking about lifestyle. How are you living? How are you eating and moving and sleeping? How is your connection with their friends and family? Because all of those pieces then support or can get in the way of optimal health and including optimal mental. 

Carrie: Dr. Akin. I think that you make a great point there that anxiety is a complex issue. It’s not just a physical health issue. It’s not just a mental health issue. It’s not just a social or spiritual health issue. This is an issue that affects many different domains of our lives and so it’s important that we’re able to look at all of those different domains and evaluate them. So I like that, that’s something that you bring to the table for people that you work with. 

Dr. Katie: Thank you. Yes. I think it’s very important that we acknowledge that no one we’re talking about any house condition. There are physical, mental, and spiritual causes and solutions for health concerns. And my approach is to look at each of those, look at the resources that people have available through that, and really work to find solutions that support people through their physical, mental, and spiritual wellbeing. I know sometimes maybe a rut that certain doctors can fall into is having a one size fits all approach.

Carrie: And sometimes the one size fits you and sometimes it just doesn’t seem to fit. And so I imagine you probably have patients come to you who have been to other doctors before, or have tried other courses of medication maybe, and haven’t achieved the results that they were hoping for. 

Dr. Katie: Absolutely. I see a lot of patients that have resistance or like what’s considered treatment resistant depression or treatment resistant anxiety. We know that the standard medications for anxiety work for about 80% of people, which is great, but that leaves a whole 20% of people who do not respond to first-line medication. Some folks go through a lot of trial and error and they don’t find something that works for them and it’s the same with natural therapies. Right? 

We have things that work very well for a lot of people, but not everything works for everyone. I have patients that certainly have tried many things before coming to see me are quite frustrated and it’s always very rewarding. We can try new tools like lifestyle supplements, acupuncture, and be able to get a different result for those patients, as well as patients who are, for whatever reason, just not interested in pursuing other avenues of care.

Perhaps they had a family member that had a bad experience with medication and they’re a little more hesitant to try it. So being able to open up more options for whatever someone’s reason is for choosing naturopathic care. I will say I also have patients that do naturopathic care alongside conventional medicine. I have a lot of patients that take medications and we work on supporting their lifestyle so that their medication doses are effective so that they can stay at the lowest effective dose that they’re reclaiming their health and their life in terms of how they want to be living and their choices.

Carrie: That’s an awesome option to like, so it doesn’t have to be completely one or the other. You can really combine both together. I like that.

Dr. Katie: I think it’s really important to know that you have lots of choices and it doesn’t have to be one or the other, we can work together so that you feel supported in your mental wellness.

Carrie: Talk with us about what you consider to be the pillars of mental wellness. 

Dr. Katie: In my practice, I mentioned that we’re talking about how things come up looking for other screens, then also assessing lifestyle factors. I call those the pillars of performance. We go through five of those: nutrition, exercise, sleep, prayer or mindfulness and connection. Those are the pieces that we talk about in terms of what are your current habits right now. Then they’re also the pillars moving through my tranquil minds program, where we really work on building up healthy habits in each of those categories. 

Carrie: Okay. So we want to dive in and talk a little bit more about nutrition today. We do have some other guests that are going to be talking about sleep. We have had an episode on mindfulness, which was really great. I encourage people to go back and listen to that. We’ve had an early episode of prayer. Tell me about some nutrition concerns that you’ve seen in your patients with anxiety.

Dr. Katie: Often when I start working with patients who have anxiety, we end up in one of two situations, nutritionally. One is people who are eating very, what they would call clean. They’re very concerned about what they’re eating. They want to eat in a way that’s going to optimize their mental wellness and they actually are often overthinking.

Then on the other side, we have people who are overwhelmed in general, or maybe not educated around nutrition. People who have symptoms of anxiety that manifest through the digestive system. Maybe they have IBS nausea, low appetite associated with their anxiety. Often these folks are not eating regularly and don’t really know even where to start.

When it comes to managing their nutrition. We always start with understanding. Where someone’s starting from. If it’s safe for them to record their food for a week, we often will do that. We’ll do a diet recording. That’s not the right first step for everyone. Some people find that upsetting and we don’t want to trigger any disordered eating habits. So always be cautious around starting recording, but once we know what someone’s feeding, then I like to look at first of all, for regular. Is someone eating often enough and I think this gets overlooked a lot when it comes to mental wellness, we think of, are you eating the right things? Are you eating quote-unquote healthy foods? We miss the main piece, which is that if you’re not nourishing yourself, then your brain isn’t getting everything that it needs in order to feel well. So people that are on a weight loss protocol or a restricted diet, they may be experiencing anxiety simply because they’re under fueled, like their body doesn’t have what it needs to feel well, and I see that more often than I do.

Carrie: I think that that’s huge and I want to circle back around to a couple of things that you said. One was, the people that are very focused on eating clean or eating a certain way, but it’s to an extreme level. There is actually something called orthorexia where it’s kind of a subset of anorexia where people will only eat very specific, limited foods that they believe to be clean or healthy for them. 

Sometimes those people can actually be nutritionally deficient because they’re not getting enough, maybe fat, for example, or enough protein in their diet. I’m sure that that’s something that you’ve probably encountered at some point or another. 

Dr. Katie: Certainly yes. I think that’s something we have to be very careful of orthorexia . Definitely in the field of naturopathic medicine there is a lot of nutritional advice that gets presented through natural healthcare and nutritionists. I think it’s something to be mindful of that each person is different and the most important thing is being fueled first. So sometimes the work is actually including more food in the diet. In fact, that’s always where I start, regardless of someone’s level of nutrition, we always start with, what can we add before we ever look at what could we maybe reduce. 

Carrie: That’s a good point. So like, if people are saying, well, I don’t really eat enough vegetables instead of focusing on cutting something out first saying, okay, well, can you add one more vegetable maybe per day, then you’re already eating. That sounds better than, oh gosh, I’ve got to stop eating junk food. Right. 

Dr. Katie: A hundred percent and that’s actually stage two of my nutritional approach, which is adding in produce and protein when it comes to managing blood sugar and helping with anxiety. It’s making sure that you have all the pieces that your brain needs to make all the neurotransmitters that can encourage people to look at what they’re eating and say, do I have a piece of fruit or vegetable in this new snack? Does this meal or snack have any sources of protein in it? For a lot of my patients, that’s a good starting point of starting to add it in by saying, oh, typically my breakfast is a piece of toast. Okay, well maybe we can add a piece of fruit to that. Or maybe you can have a toast and a fruit smoothie. That’s got some protein powder in it. Maybe you want to start with adding a piece of bacon to that toast and getting some meat in the morning. We’re not demonizing food. We’re just looking for options to increase both the protein and the produce pieces in the nutrition.

Carrie: I liked that a lot. I think that that’s a great starting point for people to help improve their nutritional intake. One of the things that you talked about was people not eating enough or not eating on a regular basis, which can also happen with anxiety. And one thing I’ve found or noticed with some of my clients is they’re not tuned in really to their body because tuning into their body means I’m noticing the anxiety symptoms. Sometimes that means that they’re tuning out the hunger signals as well. Like I’m not really paying attention to that. I’ve got to work or I’ve got to stay focused on something else and just plow forward. And next thing you know, it’s two o’clock and they haven’t eaten all day. That means they haven’t had any fuel for that day. 

Dr. Katie: Absolutely. I see that as well. I also sometimes see a confusion of hunger cues and anxiety cues. Not feeling well in the stomach, having some nausea and going I must be anxious rather than reflecting and saying, well, when was the last time I ate?

I’ve worked with many people where we’ve been able to separate those cues out and try eating. I give my patients a guideline of four to six hours. So when you’re looking at your day, especially if you’re not used to eating regularly and say, are there times where I’m going more than six hours without eating and then, or more than four hours.

And when you have anxiety, feelings of anxiety, thoughts come up and it’s been that long since you ate, just questioning, am I really worried about this, or should I have a snack? And sometimes having something to eat really alleviates some of that anxiety feeling because your brain is more fueled, you’re in a calmer place. It also takes away some of those physical symptoms that are actually hunger. 

Carrie: I think that there have been times where I’ve felt nauseous or light-headed, and I knew I needed to eat something right now. Like it’s been a while or I’ve been busy or I’ve been out doing things and you can definitely have some symptoms from that. That totally makes complete sense to me. Sometimes you just need a snack. 

Dr. Katie: Sometimes you just need a snack. I know for myself. I had an experience like this. I was picking up my daughter from daycare and had a busy day. We were walking home. So I was getting lots of exercise that day and as I was approaching home, I just noticed all of these worried thoughts were coming up for me. I was like, oh, I think my husband was traveling that day. I started wondering, is he going to get home safe? How’s this going to go? And I just was like, When was the last time you ate? Why are you worrying about this? Like there’s no reason for me to think that my husband wouldn’t come home safely that night and sure enough, it had been about six hours, so I got an after-school snack. And with my daughter, I didn’t have an anxious evening. I just had an anxious thought. So from my personal experience and from working with my patients, it’s definitely something that can be helpful for a lot of people. 

Carrie: Yeah. Can you elaborate on that point that you made about neurotransmitters and protein because neuro-transmitters are like the things that are targeted essentially in medications for anxiety, like, SSRI, those types of things are affecting serotonin. So talk with us a little bit about that protein connection. 

Dr. Katie: Protein is the building blocks of your neuro-transmitters without getting overly technical about amino acid breakdowns, and which ones become, which neuro-transmitters I always invite my patients to just consider. Do you want your body to have just enough protein to make it your neuro-transmitters or do you want to have abundant protein so that it’s easy for your body to find the building blocks? It needs to make these neurotransmitters. 

I don’t do a lot of precision medicine or genetic testing in my practice. That’s just not how I focus. I focus more on basic principles, like eating protein because I find that’s more accessible for most people who are really struggling, but we’re looking at some of those more precision pieces we get into this idea that, what if you have a genetic polymorphism or a change in your own genome that makes it harder for you to make a certain neurotransmitter or piece of mechanics in your body.

That’s important for your nervous system. One of the ways nutritionally that we look to support that is just making sure that there’s an abundance of everything that you need in order to make those systems run. But really there is no need in most people, I would say to do that precision piece as a starting point, most people are not having tons of protein throughout their day.

And so just looking at that, especially if you’re feeling anxious and your stomach’s upset, it doesn’t feel good when you eat certain foods, looking at how to get in just regular sources of protein, eggs, chicken, fish, like just food can really make a difference in making sure that you have the pieces that you need.

The other reason that I really love focusing on protein for my patients with anxiety is it’s very stabilizing to blood sugar. One of the things we’re learning about anxiety and blood sugar is that folks who have anxiety seem to be sensitive to hypoglycemia. So when they eat something that’s high in sugar, their body is very good at removing it from the bloodstream. And actually their blood sugar can go too low and cause that like, shakiness and nausea. 

You were describing earlier as like, oh, I’m hungry and I need to eat. Including protein when you eat for a lot of people with anxiety causes that to be more modulated. So less of those crashes and spikes and more of that, even blood sugar, which facilitates an even mood sugar is the fuel that our brain is using to make decisions and feed our nervous system throughout the day. So when we can eat in a way that keeps it stable, we can keep our thinking more stable. 

Carrie: That’s good. I know that it’s very easy to eat a lot of carbs and sugar, especially in the American diet and the processed foods that we have in different things. And so focusing on those stabilizing factors of protein, that sounds really helpful, and I’ve never heard anyone break it down quite like that. So I appreciate that explanation with neuro-transmitters and anxiety. We talked a little bit about eating more protein, focusing on adding things that we need to add, like produce. Are there any other small steps that you encourage people to take to help improve their nutrition?

Dr. Katie: There’s two more steps that I look at the third and know we can refer back to your earlier episode on mindfulness, but is to eat mindfully. When we pay attention to what we’re eating, we’re more likely to get those hunger cues that we were talking about earlier. Understand our fullness. We’re less likely to have emotional eating when we’re paying attention to our food and we’re less distracted and it also involves our brains. And eating and really, that’s a great tool that a lot of us forget about when we’re paying attention to our food and we’re taking time to taste and savor it.

Our brain tells our digestive system, hey, food’s coming. And that creates an opportunity for our digestion to be optimal, which we want. So we can then absorb all of those wonderful nutrients that we’ve taken all the effort to include in our diet. If you’ve taken time to chop up a salad or open a bagged salad, instead of opening something that was a little bit easier grabbing some of those like chips or fries, or even doing both, including some salad and some French fries with your food rather than one or the other. 

You want your body to be eating those and you want to enjoy them, especially when you are eating foods that you’re eating for pleasure, not just for nutritional value. You want to save for that. And those moments of joy beyond their helpfulness nutritionally, it’s soul food. It’s good for our spirits to say, this is delicious and I’m enjoying it with my friends and family. This tastes really good. Having those moments of pleasure when eating and paying attention, I think is really important. You feel like that helps our digestive system. A hundred percent when we’re tasting our food, the digestion, we always forget.

We think it starts like in our stomach, but the digestion starts in our mouth and it’s not just the chewing. We have this wonderful sensory organ of our tongue and our nose, and that’s sending information to our brain saying, hey, this is what’s coming. When we taste foods like vegetables that have bitter notes that cause our digestive system to increase its gastric juices, to say,  here’s some stomach acid, here’s some enzymes. You’re going to need this to absorb this food properly in order to break it down. 

When we really pay attention to that sensory experience, we maximize digestion. I feel like you’ve just given us all permission to enjoy our food because so many times people feel like, well, if I’m going to eat healthy, it’s like, here I am with the bran flakes, like choking it down, like, I don’t even want to be eating this, but I think that you can find good foods and eat healthily and enjoy your food.

I hope so. I think that that is really where the joy comes in. When you look at how I can increase my vegetables, how can I enjoy things like that. It’s a lot easier to do when you actually enjoy eating the vegetables. I love to cook and I’ve been on this journey of discovering my favorite way to eat all of the different vegetables. So for example, my favorite way to eat cauliflower is roasted with Kumon and lots of olive oil and salt. Yes. It has salt and it has known fat on it, but that doesn’t make it a bad food. In fact, it makes it delicious and then I eat more of it. 

Carrie: Yes. I like cauliflower roasted like that in the oven. I don’t usually eat it any other way, which is kind of interesting. I don’t necessarily like it raw and anyway, that’s a whole nother issue. But I think finding the ways that you enjoy the vegetables is important. If you’re going to be eating more of them, if you just think, oh, I’ve got to eat it this way and I can’t. I have to make myself enjoy it. That’s just going to be torture. Find some good recipes, experiment, enjoy the process and get more vegetables in your day. Tell us about your book. Create Calm. 

Dr. Katie: My book Create Calm was really brought out of my wish to share the tranquil minds method that I work with my one-on-one patients on with more people. Like I said, I practice in Ontario, Canada. So I really can only help people who are in Ontario, Canada. I was feeling really limited by that. I took my clinical methodology where we go through the five pillars of performance that we talked about earlier and put them in this book in order to educate how to go about increasing the pillars.

There’s a whole section on nutrition, which goes into depth about how to do the things we talked about today. Like including protein and produce and focusing on eating regularly and mindful eating. But there’s also sections on the rest of the pillars that we didn’t get to today: how to maximize your sleep hormones, how melatonin comes in, how you can make your own melatonin, how to think about bringing in mindfulness and how to evaluate your exercise. So that again, like we talked about enjoying your vegetables, you’re actually finding joy in movement rather than that obligatory. Well, I better go for a run because otherwise I’ll have more anxiety. 

Carrie: Good and the tranquil minds program, you actually have an online program as well.

Is that right? 

Dr. Katie: I do. So the tranquil mind was born out of my clinical work and some folks learn better from a book, but some people learn better from an online course. The training program is available through online modules where you can listen to me talk and you get access to a workbook that walks you through over six weeks kind of like a bootcamp style of revamping these health habits, where each week we’re working on a different piece of each pillar. 

So we start with eating regularly and looking at your boundaries. Then we move into protein and produce and exercise. Then we really grow from there till we reach the last week, which is our connections module. We talk about getting to know yourself, your relationship with yourself, looking at your community relationships and how to develop closer friendships. And then also your spiritual health, finding that connection to God or to however you connect with something bigger beyond our day-to-day self.

Carrie: Okay. Towards the end of every podcast, I like to ask our guests to share a story of hope, which is a time where you’ve received hope from God or another person. 

Dr. Katie: I love this question. I love this segment on your other episodes, because I think it’s so important to just reflect back and be grateful for the times where you have experienced that. I know when I look back at my life, there were a few times that I was trying to pick from, but I wanted to talk about my clinical work and seeing my patients. Sometimes I meet people and I feel like I’m looking at them almost through a cloud. If you’re trying to see what’s really going on, I always experienced so much hope and gratitude. When I feel like I can see a peak behind who this person is behind their anxiety and when I get to hear things like I don’t have anxiety anymore, or I really love myself now, I feel like I finally understand self love, that gives me more hope than anything else in my life. I’m just so grateful for the opportunities to witness that. 

Carrie: That’s awesome. That’s really beautiful. Seeing the true person that’s underneath those like layers of symptoms is great. So thank you so much for being on the show today. I think that this has been informative. I know that I’ve learned some things about nutrition and anxiety, and I hope that other people have as well.

Dr. Katie: Thank you so much for having me. It’s been my absolute pleasure. 

If you love the show in general or found this episode particularly helpful, please share with a friend. Word of mouth is always the best advertising. Just a reminder that our webinar is coming up this Saturday and it is not too late to sign up.

So go on our website: hopeforanxietyandocd.com/webinar and hope to see you.

Hope for Anxiety and OCD is a production of By The Well Counseling in Smyrna, Tennessee. Our original music is by Brandon Mangrum.  Until next time. May you be comforted by God’s great love for you.

44. How Can Improving Gut Health Help Your Mood? with Maggie Roney, MS, NCC, LPC

Written by Carrie Bock on . Posted in Counseling, Podcast Episode. No Comments on 44. How Can Improving Gut Health Help Your Mood? with Maggie Roney, MS, NCC, LPC

Today, we are privileged to have Maggie  Roney on the show. Maggie is a Licensed Counselor and Functional Medicine Practitioner.  She helps those who wish to get to the true root cause of their illnesses 

Maggie shares with us her knowledge on functional medicine and how we can improve our gut health. 

  • How does functional medicine work? What are its benefits? 
  • Is functional medicine better than conventional medicine?
  • Types of toxins we put in our body that we are not aware of.
  • The link between anxiety, stress and gut health
  • Small steps to take to achieve better gut health

Resources and Links

Maggie Roney,  MS, NCC, LPC

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Transcript

Welcome to Hope for Anxiety and OCD. One thing that we often see with anxiety is that individuals who struggle, who commonly have issues with their digestive system. They may have gone to doctor after doctor or gastroenterologist has tests run only to find out that they can’t necessarily find anything specific and it may be tied back to stress and anxiety.

Today on the show I have with me, Maggie Roney, who’s a licensed professional counselor and certified functional medicine provider. So we’re going to be talking about the connection between anxiety and gut health, too. 

Carrie: Maggie, how did you become interested in additional training? So you started out as a licensed professional counselor and then chose to become certified in functional medicine. How did you get to that?

Maggie:  I specialize also with trauma and EMDR consultants. I would see many clients that even as we, for the trauma, we worked on lifestyle choices and even lowering the stress they would still be on medications after medications. But the medications and our wants to make a, just a side thing hereof. I am not against medication. It has its place and it’s time to use it but I don’t have to go through so many and they’re not working. Then I thought there has to be a different way.

There has to be something that can be added or something that can be done. People would want to come off of their medications due to side effects that they did not particularly care for. It worked at first, but now it’s not working. So that was one reason. Another is my own health journey. I was 35 and they said, you’re completely healthy. But yet I’m on five medications that do not make any sense to me. None of them were things like pencil lines and as I learned more and I went on my own health journey, I thought I can really integrate these two and help someone out and that’s whenever I sought out and printed, the certification.

Carrie: Okay. I know a lot of people who have experienced trauma. We talked about how trauma is stored in the body. This is just one way it can manifest in terms of digestive issues, but it can also manifest in terms of muscle tension, sexual dysfunction issues and a whole host of other things. A lot of times people don’t necessarily connect that back to the traumatic experience.

You and I had talked off-air about auto-immune issues that people have. Oftentimes that’s very common with trauma, like fibromyalgia.

Maggie: Yes and it’s not even okay. It’s a traumatic event that caused that. Lifestyle choices and stressors that keep on working through and someone may get a virus and that’s what kicks the body into an auto-immune condition.

Carrie: Gotcha. It’s interesting to me how much overlap there is in our emotional health, mental health and our physical health. Unfortunately, a lot of times, those seeking help are very polarized. Perhaps the counselor may not be talking with the primary care physician and vice versa to really figure out and get to the bottom of what’s going on.

Have you seen that with your practice as well? That those areas tend to be silenced and people aren’t communicating as much. 

Maggie: I have. I do believe that more often than not counselors do try to reach out. It’s kind of split under the rug — “Okay, good. You’re taking care of your mental health. That’s fine. But you leave everything to me.” Sometimes you have to find positions that are receptive to different ideas. Even as a therapist, you can say, “I have this insight, can you help me understand this part of it?” That can be difficult, but I do see where there is just not enough communication.

Carrie: I think it can be hard for clients too if they’re honest with their medical practitioner to say, “I have anxiety.” They’re afraid a lot of times that their symptoms will be dismissed. That’s automatically your anxiety versus fully looking into the different aspects of it. Right? How can functional medicine benefit people in a different way than traditional Western models of medicine?

Maggie: Unfortunately with Western medicine and many advancements that we have made, it is not a one size fits all. If you have anxiety, here’s your protocol. Here’s what you do. Here’s your perspective. We see you in a month to three months with functional medicine.

We look at you as an individual. What is it that you are needing or could be doing differently? You could have the most summary of chronic stress, the cause may not be considered something big like divorce or death or something of that nature. It could be a high stress job. It could be insomnia and then we look out for the underlying reasons. Do you have a mammal or a vitamin deficiency? Do you have a genetic capability or a genetic condition that causes it? Or you may need a little bit more supplementation in one area versus another. Is it that you have food sensitivities exacerbating symptoms that you are experiencing? It is really getting down to the root causes for that individual which unfortunately is a lot of just toxins practice. 

Carrie: If you’re able to eliminate those things, then you’re able to feel a lot better physically is what you’re saying. 

Maggie: Yes. 

Carrie: Talk with us about toxins, like what kind of toxins do you see that the people are dealing with or consuming? Maybe it’s something that we aren’t fully aware of.

Maggie: No, of course the die die, obviously for ADHD, The anxiety process is a lot of this. We have things that we can’t even connect and those have difficulties with the body to break down and utilize some nutrients and it can create and test on permeability, which we can get into just a little bit. Other toxins can be our personal care products. For some reason here in the United States, they allow so many more ingredients that are banned in Europe and they have severe fines and can shut down your business. The Roundup weed killer, it is FDA approved, even though yet the FDA says, okay, it causes difficulties, but the FDA approves it to be utilized for weed killer. We then ingest that and that has a tremendous effect on our bodies.

Another thing as great as technology is, we all love it especially over this last year. It’s safe but all of the Bluetooth and the WIFI and all of that, has EMS electromagnetic fields that can be very damaging to our health. It causes ourselves to oxidize or cross the free radicals which are very damaging to us and our bodies can’t keep up and work on getting those out. It can be heavy metal toxicity. Not just lad, but mercury and that billings that you had 20 and 30 years ago that can still be in the body needing to detox. If our body doesn’t do a job detoxing, what it does is it stores it in the body but then that doesn’t function that makes us healthier. 

Carrie: Why is gut health so important to our mental health? 

Maggie: It used to be known that serotonin and dopamine are just made in the brain. However, scientists have discovered that in our gut, we actually have a third nervous system called the Enteric Nervous System. When we eat food, when the digestive process begins, and even whenever you smell the food, it releases enzymes to tell the stomach to get ready. It tells the stomach to make acid to break down the proteins that are coming and get everything that needs to go to the small intestine, the large intestine, and we will utilize what is needed in our gut.

We make 95% of our serotonin then it comes up with a nerve called the Vagus Nerve that goes from 60 to 70% of a person’s dopamine which is for motivation. If our gut is trashed, but if you are in your thirties to forties, we came from the age of using antibiotics for sore throat, stuffy nose, and headache.

Our guts are trashed because we have bacteria that live in our gut that help break down the food, help take the nutrients, utilize those nutrients and get them to where they need to go to be used. Those nutrients are needed to make the serotonin and to make the dopamine. That’s pretty much why the gut is so important. 

Carrie: That’s so interesting to me because I don’t hear psychiatrists talking about this with their patients when they’re prescribing medication for SSRI or others for depression. They’re not saying, “Hey, what is it that you’re actually eating from a holistic view? Are you eating a lot of processed food? Or eating a lot of fast food?”  And we get into this negative cycle where we don’t feel good. Then we don’t really feel like doing the good things for ourselves to take care of ourselves and then we’re putting that stuff in our body. And then we’re back to not feeling good again because of what we ate or how we treated ourselves.

It’s a hard cycle I think sometimes for people to get out of. I mean, would you agree with what you’ve seen?

Maggie: Absolutely. You talked about psychiatrists not talking with their patients and some of them just don’t know, and it’s not because they’re not good psychiatrists. But in medical schools, they take one semester on nutrition. They take two years on pharmacology and again, are highly respected, but unless they go out and they seek further education on that, then they won’t know and I’m sure they don’t have time, the way it is. But I wish that they would, and I wish that as needed as antidepressants are or anti-anxiety or anxiety medication, something that we certainly never learned in school or I did — the longer you take the SSRI, your body just stops making serotonin because it figures why we don’t need it.

It kind of stops and then, when people decide, “Hey, I’m going to get off my medication”, their body isn’t used to making serotonin and that takes a little while.

Carrie: Sure but they can. It can rejuvenate and relearn to do that. 

Maggie: Yes. 

Carrie: Okay. Good. That’s really interesting because those medications are often prescribed for OCD as well and in certain higher doses. I think that this topic is very important. What kind of toll does stress have? Cause you talked about stress a little bit earlier and anxiety takes on the body specifically related to gut health. How does that stress affect our gut? 

Maggie: Whenever something major happens, your adrenal system goes into overdrive.

That’s when your sympathetic nervous system says, it’s fight or flight. We’ve got to go, go, go, go, go, go and do, do, do, do do. Unfortunately, the brain can’t tell us or it doesn’t decide. They’re just doing normal everyday life. They’re just really busy and they don’t sleep long. So no, it just goes simply off of the nerves that are kind of firing in the brain, we need to enact this.

So that can be one thing, just a very high-stress life and you ask people today, “Are you stressed?” No. “Okay. Well, how much do you work?” 70 hours a week. That’s anywhere from 50 to 70. I’m finding it to be a pretty normal number. Then I have kids’ activities and can’t sleep, and then I’m taking care of my mom.

So all of those are stressful factors. Even though for us, we have kind of gotten it ingrained in our brains. We go more, we do more, we get more done and we’re better. We’re more successful, although we’re feeling awful. So it can be something very simmering as a toxic situation at work, a very unhealthy marriage just kind of day in, day out and large event rate for death or trauma of abuse. 

Carrie: We’re definitely living in a day and age where more and more people are experiencing chronic stress and I think you’re right. They’ve just kind of normalized it like, well, isn’t this what everybody does, you climb the corporate ladder and you have a family and you have a social life.

I mean, I don’t have time to exercise three times a week or prepare meals. And it’s in a lot of our priorities in what we’re choosing to spend our time on. 

Maggie: Right. 

Carrie: So is that something that you do as part of the functional medicine approach is help people figure out how to make the dietary changes and the lifestyle changes that they need in order to feel better and take better care of themselves.

Maggie: Yes and it’s not just, I see this on your paper so you need to do this, this and this. We talk about what is the motivating factor for them to keep this behavior in and then also explain down to the science of this is what it’s truly doing to your body and this is how it’s affecting your nervous system. If you are in constant sympathetic nervous system mode, you’re not digesting your food, you’re not replenishing, you’re not sleeping and truly sleeping to where your body restores itself. You’re not getting to the place where your body can utilize the food you even eat. It won’t even recognize it. Therefore, you’re not making serotonin, you’re not making Gabba. You’re not making dopamine.

Carrie: Being in that fight or flight state really arrests the digestive system because that has to come from the other part of our nervous system, kind of like being more relaxed. 

Maggie: Yes.

Carrie: Yeah. I think so many people don’t know that or they don’t realize that what are some small steps you would say that people can take to achieve better gut health?

Maggie: I would think the first thing is to really look at your schedule and kind of prioritize what is important for you and what do you want to accomplish. Whether it’s in the day or the week and beginning to really have the activities that are self-care, whether it’s exercise, spending time with others and being social.

It is very important to have those deep relationships with others. Another thing would be to look at what you are eating. This doesn’t mean you have to eat salads all the time and never enjoy anything. Trust me. I love some pizza and if you put peanut M and M’s in front of me, it’s going to be really hard and starting to fail, even though I know I’m going to feel awful the next day.

And sorry that I love a good margarita at the same time. I may have to watch when I eat those things, but watch for the amount of sugar that you are eating. Sugar is terrible for our bodies. It causes such an inflammatory response, even though it may not when you are in your teens and twenties, but it will add up and kind of begin to look at different areas that you would like to detoxify.

Whether that’s in cleaning, there are chemicals in there that are neurotoxic. There are chemicals in there that affect our Endocrine System, which makes our hormones. There are things that affect our adrenals which then affect everything in our body. So really look at all of your products that you have. 

Another thing would be, when your doctor says your laboratory work looks great and you are in good health. Actually ask some questions and look at it. Well, it’s within range, but is that the best range for me? Those are some basic areas.

Carrie: Do you have people that come to you that their labs look great? But they kind of don’t feel good or they don’t feel like themselves, or they feel like they could be at a better place of health.

Maggie: Yes, everything is completely within range. The standard range of here’s what the lowest person is normal. Here’s the highest person that is normal. They’re all within range, but it’s not at its optimal for that person. Looking at the relationships with these different results, we can tell that you have benefited from digestive enzymes for whenever the stomach breaks down proteins or it kind of indicates you’re low and the basics for being nine. Those types of things, which are B6 is probably one of the most prevalent BS that is needed to create neurotransmitters and to create energy in the cell site.

Carrie: Okay. Awesome. It sounds like there’s a lot of different options that people have, whether that’s diet changes, supplement reducing stress in order to get to a better place. And trusting that inner intuition of your own body when you feel most optimal. When you don’t start really paying attention to those cues like, when I eat these certain things, I notice I feel this way the next day. Or if I eat those things, I have more energy or I feel a little bit better. It can make a huge difference by making small changes, just in tune with where we’re at with our own bodies. 

Maggie: Right and that is difficult because I think that we are taught or at least it seems that way to just ignore your own body and just keep going. Well, they said everything was normal, so I don’t know, maybe I’m making this stuff in my head. Then excuse that it is normal and don’t even pay attention to it until then we have other things. I’ve talked to several clients and they will say I was fine until this year and then all of a sudden I have type two diabetes and hyperthyroid and it didn’t happen all of a sudden. We kind of delve into what happened, the root cause and work on reversing those issues. 

Carrie: This has been, I think, very informative. So towards the end of every podcast, I like to ask our guests to share a story of hope, which is a time in which you received hope from God or another person.

Maggie: The first thing that came to my mind would kind of in a way, be my testimony. I believed as a child and then through my twenties, just some things happened and I thought, nope, nope, no, God, no, God. Well with my son, when he was in the third grade, he became suicidal and he was just kind of out of nowhere and it didn’t seem right.

Something wasn’t adding up and I got him to a different place and different school. We ended up switching schools, he wasn’t bullied or anything. We couldn’t figure it out and then we decided on medication. Things got a little bit better, the following year he became suicidal again, and then a break in the next year, the third year, and then suicidal again.

Well, we eventually found out and I know this is extremely controversial, but this is my story and my experience. We found out it was a vaccine injury. Every time he received this vaccine, it was 11 to 13 days later, he would become suicidal. It didn’t click until that third time I thought something was different. He had been on medication for years and years. 

Through that experience, whenever your child is suicidal, I just said, “Okay. I don’t know what is up there but just help.” I didn’t bargain or anything. When the first time I saw him happy and running into school and the sunlight was shining down on him, I took a picture of it and I sent it to his teacher and I said, “This is hope for me” and this secures my faith.

It was the most peaceful feeling I had knowing things were going to be okay now. Yes. We still had a rough few years and we had to detoxify him of the heavy metals. Now he is off all of his medications and doing great.

Carrie: Does he still struggle with anxiety? Certain things happen, changes and all of that? 

Maggie: Yes, but that’s why he has tools that he’s learned from other counselors. But that honestly was the greatest moment of hope I’ve ever had in my life. 

Carrie: That’s good. I think it was very perceptive for you to be able to put those things, those dots together, and be able to advocate for him to get what he needed at that time. Trying to look at it from a holistic point of view, I think that’s really important. 

Well, thank you so much, Maggie for coming on and talking with us about functional medicine and gut health. I think it’s been very interesting and informative and hopefully it will help some people kind of think through their life and how they can make further positive lifestyle changes.

Maggie: Thank you so much for having me. 

Carrie: Just a reminder that in two short weeks on Saturday, September 11th, we are going to have a webinar on dealing with difficult thought processes. This is a great opportunity for me to be able to connect with some of my listeners and I absolutely love that. So if you can join us, we would love to have you there.

You can find out more information and sign up by going to:

www.hopeforanxietyandocd.com/webinars. Thank you so much for listening. Hope for Anxiety and OCD is a production of By The Well counseling in Smyrna, Tennessee. Our original music is by Brandon Mangrum. Until next time may you be comforted by God’s great love for you.

25. Making Church a Welcoming Place for People with Mental Health Struggles with Dr. Steve Grcevich of Key Ministry

Written by Carrie Bock on . Posted in Anxiety, OCD, Podcast Episode. No Comments on 25. Making Church a Welcoming Place for People with Mental Health Struggles with Dr. Steve Grcevich of Key Ministry

I had the privilege of interviewing Dr. Steve Grcevich of Key Ministry.  Dr. Steve is helping churches learn how to minister to people with disabilities including mental health. 

He shares about what moved him to begin his mission of connecting churches with families of kids who have physical and mental disabilities. 

  • Different scenarios and social interactions in church that trigger the anxiety in kids and families.
  •  Barriers that make it more difficult for kids and families to be part of the church.
  • How to help kids and families with anxiety and other mental health issues feel welcomed and included in church.
  • Communication strategies and inclusion plan to help people feel more welcome in church.


Links and Resources

Key Ministry
Book: Mental Health and the Church

Support the show 

More Podcast Episodes

Transcript of Episode 25

Hope for Anxiety and OCD episode 25.  Today, I had the privilege of interviewing Dr. Steven Grcevich. I believe that’s how you say his last name. He also told me I could call him Dr. Steve. Dr. Steve is going to tell us about a ministry that God laid on his heart to start that helps churches know how to reach and effectively minister to people with a wide variety of disabilities including mental health. So without further ado, let’s get into the interview. 

Carrie: Tell us a little bit about yourself.

Dr. Steve: Carrie, thanks so much for having me on your podcast. I wear a lot of different hats. So in my tentmaking job, I am a child and adolescent psychiatrist. So I’m with physicians. I went to medical school, actually, I got accepted into medical school when I was 17 years old. It’s a little bit of a Doogie Howser kind of thing through an accelerated program. I have a private practice in suburban Cleveland. I teach at a couple of different medical schools, the child psychiatry fellows. I helped teach evidence-based medicine to medical students. Again, maintain a practice. I do some training for Mental Health Professionals and some of the surrounding counties. And then the other thing that probably takes up about half of my time is that almost 20 years ago, I was involved with starting Key Ministry, which I think we’re going to talk a little bit about today. 

Carrie: So, how did you get to that place of seeing a need for key ministries or a desire to start that?

Dr. Steve: This is probably about 25 years ago. I was on the elder board at my church. This is mid-1990s after the fall of the iron curtain.  We had a whole cohort of families who went over to Russia and Bulgaria and adopted some kids with some really complex emotional behavioral, developmental issues, trauma out of orphanages in Russian Bulgaria after the fall of the iron curtain.

And I’m sitting at an elder board meeting and the person who at the time was our children’s ministry director ended up on our ministry board later on down the road. I came in to do a presentation to talk about some of the struggles that these families were having in terms of staying engaged with church. As you can imagine that these were folks who had been very devoted, highly committed. These are people who are volunteering. They’re serving in leadership roles.

And then kids with other mood disorders kind of in that order. And so not like anything that we would go ahead and submit to a journal or as some sort of formal study. Over the next three months, I just did a survey of families as they were coming through the office for routine follow-ups.

There was one question, “what impact did the challenges that brought you and your child to our practice have on your ability to participate at your church or place of worship?” And I was floored by some of the stories that we started to hear. One in particular that was really memorable was that there was a family that I was seeing where they had a couple of little boys with pretty severe ADHD.

They started describing to me sort of what their experience was like going out, trying to find a church for their family on the west side of Cleveland with these two boys in town. Interestingly enough, they ended up at our church. And we’re giving their testimony at one of the services, talking about the impact that the supports that our children’s ministry was able to offer it had on their family. And the comment that the mom made is the people in the church oftentimes think they can tell when a disability ends and bad parenting begins. And so we oftentimes find that when we have kids with different emotional behavioral issues, and in my practice, I see this a lot, where kids who are anxious oftentimes manifests in anger, moodiness, and irritability.

I’m sitting there, listen to this stuff became obvious that there was an issue. And as God would go about orchestrating things around that time, I had one of the three original research grants for Adderall, which became the most commonly used medicine in kids with ADHD.

I got asked to travel around the country, do a lot of lectures to different medical groups, physician groups. And in the introduction, wherever I went I would say something about the work that our church was starting to do with families who were having some of these kinds of struggles. And the church started getting inundated with requests for help. Basically, Key Ministry came about.

Our current mission statement is that our mission is to help connect churches and families of kids with disabilities, for the purpose of making disciples of Jesus Christ. At the core of that, and sort of our original focus on what we saw as the unmet need was that our focus was on helping churches welcome and include families of kids with quote, unquote hidden disabilities, emotional behavioral, developmental neurologic conditions where the disability wouldn’t be obvious, say in a still photograph of that child. Johnny is just an absolutely wonderful lady. She did great work in terms of helping folks with physical disabilities be part of that. Around that time, the early two-thousands, we began getting like more and more awareness of some of the challenges. For example, families face when they had kids on the autism spectrum as more and more kids got diagnosed.

So, the next wave of this is that churches became very proficient or many of them became proficient. There were good models for serving families where they had kids who quote-unquote special needs. Basically kids with more severe intellectual or developmental disabilities, but by far and away, like if you take a look at the child population in the United States, 75% of kids with disabilities have primary mental health disabilities.

And there’s some fascinating research that came out a couple of years ago. Andrew Whitehead, who was a sociologist at Clemson University, went through about a quarter-million interviews with parents from three waves of the National Children’s Health survey. It’s done every two to three years by the federal government.

This is where they get these statistics that like one in 46 kids has autism, stuff like that. And interestingly enough, one of the questions that they ask as part of this is, “has your family attended a church or a place of worship at any point in the last year?” And what they found was that families who had a kid on the autism spectrum were 84% less likely than other families unimpacted by disabilities to ever set foot in a church. But it was 72% for families where they had a child with depression, 55% for kids with a disruptive behavior disorder, oppositional defiant disorder, conduct disorder, and 45% when we’re talking about kids with anxiety disorders. There’s actually 19% for kids with ADHD. In comparison to that, when they looked at other disabilities, like for example, Tourette’s disorder, kids with intellectual disabilities that didn’t have much of an impact in terms of church attendance at all.

And so when you start talking about sheer numbers and so in the population we serve, children and teens, probably about one in 10 meets criteria for a significant anxiety disorder. The number of kids and families who are impacted by these mental health concerns is far, far larger than the number of families who struggle with what we have traditionally referred to in the church as special needs.

So within the context of what we do in our ministry, there’s a lot of stuff that we do that we put on an annual basis. We couldn’t do it last year because of COVID, but the largest disability ministry conference in the United States.

We have a group that we moderate for 2100 special needs and disability ministry leaders from around the country. So we do all kinds of training consultation, offer all kinds of free support to churches.

My role specifically had been to work on developing a model for churches that are interested in doing mental health inclusion. So we have other folks on our team who will consult and work with, again churches that are looking to serve kids with sort of the traditional intellectual developmental disabilities.

[00:10:44] My piece has been developing a mental health inclusion model that churches can follow if they want to serve this larger population of families. That is probably, and it’s interesting, there’s guy Lamar Hardwick who’s up. Fascinatingly, he’s an African-American pastor of a mixed-race church in Atlanta who was diagnosed with autism in his mid-thirties, wrote this book called Disability in the Church.

And one of the points that Lamar made is that the largest minority group in the United States are individuals and families affected by disability. With all the conversations that are going on in terms of talking about diversity and the need for our churches to become more diverse, one of the places we need to start is by thinking about folks who have this range of conditions. Where many of them, the presence of their mental health condition or the presence of a family with that condition has made it impossible for them to be part of church.

Carrie: Can you talk a little bit more about that as far as what specific things were they encountering that were keeping them from being able to go to church? Like lack of feeling welcome maybe because their child had a disability or just their child being too anxious to be in a group setting. 

Dr. Steve: So what if we take a look at sort of mental health, if we think about sort of mental health collectively as a whole, in the model that we put together, part of what we train churches around is the idea of there being seven barriers. The first one is stigma. In that, for example, there was a study. This is maybe six or seven years old from Lifeway research, where when they interviewed quote-unquote unchurched adults, 55% of them endorsed the notion that people with mental illness aren’t welcome at church. 

Carrie: That is so sad. 

Dr Steve: And interestingly, in some of maybe the more theologically conservative denominations that are more focused on outreach and inclusion, like going back to theological devotee, sixties, seventies, and eighties tend to be the ones that have less insight and less understanding about the nature of mental illness. But no, this stuff is not necessarily a sin problem. There are things that people are born with. And as you know, in your practice, that there are ways in like the lives of individual people who wrestle with this so that there are ways that God uses this stuff in terms of drawing people into closer relationships and deeper relationships. So the churches that are most interested oftentimes in doing outreach and inclusion are the ones that in some instances are the places where maybe mental health concerns tend to be more stigmatized. So that’s the first one. 

The second one is anxiety. And I would argue that that in and of itself. Of all these barriers that’s probably the most common one and the anxiety disorders out of all the different mental health disorders are the ones that are most likely to keep the most people out of church. But we’ll talk about that a little more in detail. 

The third has to do with executive functioning and self-control. Pretty much every mental health condition that you think of ultimately, or to some degree will impact people’s capacity to self-regulate emotions, to modulate impulse control, to be able to plan to exercise self-discipline. And folks with conditions like ADHD would be sort of the prototype of this.

Again, there are many other mental health conditions, significantly impacted. If you’re a family and if you have a kid who has a hard time sitting still, or not shouting out in the middle of a worship service. I had a very memorable case. This was a family that came from out of State to see me.

This may be 15 or 20 years ago where the father was a Southern Baptist pastor in Appalachian, West Virginia, Virginia, somewhere like that, where he came up to see me. And actually, his family doc gave him the money to come on up to our practice where they had adopted a little boy who had pretty severe issues with ADHD and impulse control or aggressiveness.

Shortly after they adopted this five-year-old boy, he punched the son of the guy who was the chair of the elder board. And they fired the father for not having appropriate spiritual control over his family when it was obvious that they adopted this kid who had been through very traumatizing situations.

But when you think about like in the Bible and you think about scripture, like the book of James, self-control is very closely acquainted with sort of godliness and spiritual maturity. Ability to demonstrate that especially for kids becomes like really important. If they’re going to be able to fit into a lot of activities at church.

The fourth is sensory processing. Folks think about this as being an issue with folks on the autism spectrum, but it turns out that folks with pretty much every condition and DSM can experience issues with sensory stimulation. And it’s particularly common, in addition, autism among folks with anxiety disorders and ADHD.

And so that for some people like the bright lights, the very loud music, the very sort of stimulating worship environments. You see in a lot of the contemporary churches, for some folks becomes absolutely overwhelming to the point that it’s aversive. 

The fifth is social communication. We think about churches by nature are intensely social places.

And so if you’re somebody where maybe you feel uncomfortable with self-disclosure with other people or you have a more difficult time picking up on tone of voice, inflection of voice, body language, facial expressions, you’re really going to struggle in terms of like the interpersonal stuff that goes with those being active at church. 

The sixth is social isolation because as you know, think about folks with common mental health conditions, people with depression isolate, oftentimes as a symptom of that depression. Folks with social anxiety oftentimes they’re going to avoid situations where they’re going to come in contact with and meet a lot of people and make a lot of new friends. Families who have kids with mental health issues.

The kids are less likely to be involved with athletic activities are less likely to be involved in extracurricular activities. They are less likely to be in situations where they meet other families who will invite them to church. Not to mention the fact that for a lot of the kinds of families that like your practice serve and that we serve, mental health treatment can be fairly expensive.

And a lot of times, I mean that there are lots of treatment costs that these families are incurring either for themselves, for their children, and either finding babysitters or childcare is too expensive. Or when you have a kid where you just can’t let any 14 year old down the street come over and watch them. It was very hard to become part of the social fabric of your neighborhood or the community. 

And then the seventh one is past experiences of church because I don’t know about you, but about 30 minutes into child psychiatry school, I think I figured out that the apple doesn’t fall far from the tree and that the kids who have these struggles oftentimes have parents who have these struggles.

And so part of the challenges is if the parent had an issue that kept them from being part of church, when they were younger, it’s highly unlikely that any of their children in particular kids who may have a similar mental health condition are going to be part of church. So those would be sort of the big ones that we ask churches to think about. Stigma, anxiety, executive functioning of self-control, sensory processing, social communication, social isolation, and past experiences at church. 

Carrie: One thing I will say about that, that’s interesting is there’s this thing with church, it seems like with leadership and wanting to reach people where you either get one of two situations with a church.

You either walk in the door and it’s almost like everybody attacks you. Like you have the football like it’s “so we’re so excited to see you and, oh, it’s such a great day. Have a good Sunday. Here’s your bulletin.” You know that you either get that response or you kind of sneak in the door and then you sneak out the door and no one talks to you. But then maybe you go home and you go, “No one talked to me at church today” you know, I guess they really don’t care about me.” So how do churches like find this balance and this fine line between reaching people and letting them know that they’re loved and cared for in that environment without overwhelming them? 

Dr. Steve: One of the first things that we try to help churches to do, because the level of understanding, again, from church to church, depending upon what kind of education the pastors have had, the people who are serving on staff at that church can vary so much. One of the places that we’ll start is by helping to kind of educate them about some of the things that they would anticipate being struggles in folks with common mental health issues and to kind of try to put them in their shoes here. I’ll give you an example of a little exercise that we would use as sort of like a little starter, like if we’re going in and if our team we’re doing a big training or if we were training an individual. 

Let’s imagine that Samantha’s family lives down the street from your church. Samantha’s a single mom. She has a nine-year-old son and a seven-year-old daughter. The nine-year-old son got invited to vacation Bible school loves it, wants to go church every week and is begging mom to take the family to church. The nine year old son has ADHD and dyslexia. His seven-year-old sister has a separation anxiety disorder and the mom has social anxiety disorder and agoraphobia.

Think about all of the potential places where something could go wrong and where they might encounter a problem the first time that they would go to attend a church. And so one of the ways I talk about this with families in our practice on the church leaders is that as you know from a lot of the research has been done in terms of neuroimaging. To try and understand what’s different in the brain in folks who struggle with anxiety disorders is that we know that they’re basically hardwired to overestimate or distort the level of risk involved with entering into new or unfamiliar situations.

And so think about what that’s like if you’re visiting a church for the first time. For their family, one of the places that’s going to start is I would bet that mom is going to be looking on that church’s website before she even thinks about putting her kids in the car and going, because the kinds of things she might be worried about would be, “Am I going to stand out?

Will I be dressed differently than everyone else? Will my kids be dressed differently than anyone else?” But there are enough sort of strange stories floating around. It’s interesting, my son-in-law and my daughter in medical school, down in Alabama. And I heard stories from my son-in-law when he first moved down there, it was like looking for a church and, “oh, he was a newcomer.”

And so everybody stood up in the church and came around him to lay hands on him, to welcome him. Yes. So again, if you’re a mom with social anxiety, even the most remote prospect of something like that, or having somebody walking around during prayer time, handing you a microphone, and asking you to introduce yourself, it would be terribly overwhelming.

So you get over that. You figure out how you’re going to dress and you get to church. How many social interactions does mom have to navigate the first time she goes before, she herself, is able to go into the worship center and sit down. So you have the greeter in the parking lot. You probably have like the greeter or the person at the main entrance or the entrance for children. Now because of there for the first time, she has to register both of her kids.

So that there’s like the children’s ministry volunteers who are at like the check-in and the worship center. And of course, they’re going to want to introduce them to the volunteer people who are teaching their Sunday school class. And maybe if the church isn’t too large, probably the guy, the children’s pastor or the student pastors probably going to come over and want to introduce themselves.

So by the way, when the daughter finds out that the expectation is that she will be hanging out with like other girls in the first or second grade Sunday school class, and not with mom on the other end of the building in the worship service, the daughter starts to have a meltdown because of her anxiety at the prospect of being apart from mom.

So by this time, they’re already like five minutes into the worship service, Mom gets to the worship center. And mom with agoraphobia finds there are only middle seats open in the front five rows in the worships. 

And then is there some time during the service where people are expected, like pre-COVID to greet each other and people are shaking hands and hugging on your way out. You have people who are a lot of places have like a welcome center for like new visitors. If you fill out the card, somebody may go ahead and give you a phone call afterwards.

And what if you find out that like people who joined the church, one of the things that you’re expected to do is you’re expected to very shortly thereafter become part of a small group with a group of total strangers in which there’s an expectation for folks to disclose fairly personal things. That’s why you tend not to see so many anxious people oftentimes at church.

And so part of what we’re doing when we’re working with churches is that, in contrast, to something like special needs ministry or something that’s a standalone program. This is not a program. This is a mindset. And so that we’re trying to get pastors and folks on staff at churches to understand some of the things that are going to get in the way, because like the best inclusion strategies are going to be things that are going to help everybody.

And in particular, one of the reasons why the ways that we had traditionally done disability ministry didn’t work and don’t work for the folks that we’re talking about is it the last thing that my patients want to do is to be part of something that’s going to single them out as being different.

And in fact, my kids and teens, what they want more than anything else to be treated just like everybody else. So, you can’t put them in a special needs ministry or you can’t expect the folks who we’re working with kids with autism or developmental disabilities to have a good handle on what do you do with the kid with profound social anxiety or the kid on the autism spectrum with 147 IQ who has no social skills and is very awkward in terms of how they interact with other folks.

Carrie: Have you had churches that did certain things to help with kind of getting people through that front door. That’s probably the scariest part is kind of the whole process of entering the worship area for the first time, dropping off your kids, those types of things that you just mentioned. What does that look like in a more anxiety sensitive, I guess. 

Dr. Steve: Okay. So coming back to like what we were talking about before. The more people with anxiety can visualize an experience, especially if they’re going to an unfamiliar place, the easier it may be for them to be able to get over that hurdle. So one of the things that we talk about when we’re working with churches and one of the components of what we have them think about doing is a communication strategy.

One component of that is to take a look at your website. And you want as many pictures, video. You want folks who are exploring the website to be able to have a good picture in their mind of what it is that they’re going to be able to experience. And so this is where this would be especially true is that I have kids in my practice where for example, they’re okay at going to church. And by the way, one of the ways that you figure out who the anxious kids are at church is walking into the worship center of the sanctuary, like when it’s time for the sermon and see who’s still sitting next to their parents. That’s probably like a pretty good bet. I have kids where maybe they can get to church and, you know, they can sit with mom or dad, but the prospect of going to like Sunday school would be overwhelming.

One really memorable kids. So there was in like third grade. This ADHD separation anxiety, some dyslexia kid ended up doing well with some cognitive behavioral therapy ended up in a private school that specializes in working with kids with learning differences. Didn’t hear anything from the family for three years.

Kid is in sixth grade and at the church where the family’s going, he’s not part of Sunday school, but he is going every Sunday with mom and dad. And the biggest event of the year for middle-school ministry was this weekend retreat. And the mom and dad were friends with the middle school pastor who put a great deal of pressure on them to have their child go.

Well, the kid was still struggling with lots of separation anxiety. And when the kid came home one day and considerably larger at this point, when mom informed them that they needed to go to the retreat, the kid became extremely agitated and aggressive. And if mom’s brother had to have just happened to drop by the house, this boy was so upset that she might’ve gotten seriously hurt.

So, the kid has separation anxiety. If we added the details that the middle school retreat is for a full weekend on an island in the middle of Lake Erie that you can only reach by ferry that only runs during the daytime. Can you imagine?

Carrie:  There’s all these barriers.

Dr.Steve: Yeah. So for example when you’re asking people to do something, that’s like a little out of the ordinary.

So with a middle school retreat or a high school retreat, or like churches where people go on mission trips, the same thing applies that an anxious kid would want to know. What am I going to be doing? Where am I going to be eating? Where am I going to be sleeping? Or they’re going to, you know, are they cabins?

Are there going to be bugs around? What’s going to be happening all day long? So that, to the extent that you can go ahead and help folks to visualize that whether they’re serving in a soup kitchen or going on like a weekend or like a week-long retreat to like Appalachia, or whether it’s like two days with other kids from middle school and high school. The more you can envision of what you’re going to be experienced and the more you can prepare folks the better. So, the same thing when you think about this with, in terms of say kids who might be dealing with some degree of anxiety. Making sure that you have maybe other kids around who are greeters, who come from a number of different schools.

So the kids are likely to see familiar faces when they come in the same way. Like for example, I think about some of our kids with anxiety who have difficulty transitioning when they’re going to a new school. Giving them the ability to come and check the church out, maybe in the middle of the week, when there aren’t a lot of people around and either to like meet in person or maybe meet by video their Sunday school teacher so that, here’s where your room is at.

Here’s where you’re going to be going. Here’s what you’ll be doing. The more preparation you can do with someone, for example, who struggles with anxiety, the easier time they’re going to have with it. 

Carrie: These are really good ideas. I think in terms of being able to visualize things I used to have before COVID and I went fully online.

I used to have all kinds of pictures on my website of the office. And I actually paid a professional photographer to come in and take pictures so that people could kind of see the journey from literally like the parking lot to the waiting area, to the hallway where my office was in the suite.

And it was really neat because the photographer actually told me that whenever his wife goes to a new restaurant, she looks up the pictures online just to kind of familiarize herself with the area. And I thought that that was really interesting. So, I think it’s a great idea for churches to use things like pictures or videos, which is a pretty simple solution.

To snap some different pictures and put it on the website to help people feel more welcome or they know what to expect when they’re walking in the door. 

Dr Steve: Yeah, I would add, I mean, there’s some very simple things that churches can do in terms of implementing a communication strategy that are very helpful when you’re dealing with families that are impacted by anxiety, other mental health conditions. In an earlier Lifeway survey, when they asked family members of adults with serious mental illness what they most wanted from their churches was for their pastor to talk about mental health-related topics from the pulpit. It gives everybody else permission to talk about it.

There was a fairly large, interestingly enough, Southern Baptist church here in Northern Ohio that we worked with, who they ended up developing an inclusion plan, where they won the regional award for cultural competence from the National Alliance for Mental illness.

So like some of the things that they did speaking into this is that they did a five-week teaching series on what the Bible has to say about anxiety to address the issue of people feeling more comfortable about self-disclosing. I was there on a Sunday at their worship services because I was training about 75 of their children and student ministry volunteers about how, what they could be doing in terms of interacting, including kids in their ministry.

So I went to a worship service and they ended up renting a video about three minutes long that day with one of the guys who was in their worship band, who talked about his experience with panic attacks and how that impacted his faith for a period of time and how he worked through it. The guy who is a founding pastor of the church did this wonderful. It’s about five minutes long. It was a Facebook video that they produced specifically for folks in the congregation of the church to share with their friends and neighbors who might be struggling. And he started off, “Hi, I’m Rick Duncan. I’m the founding pastor of Kyla Belly Church. And I want you to know that those of you who are struggling with mental health concerns are welcome at our church.

My father was a pastor. He struggled with depression. We know what this is like.” So something as simple as that, that that’s. So de-stigmatizing put in the hands of the people of the church to share it with their friends and neighbors who they know are wrestling with this. I mean, they’ve done a fabulous job. So, in addition, they have, they actually have a licensed therapist

who’s on staff at the church to be able to see folks who have issues. They have a celebrate recovery group. They offered NAMI groups. We are seeing like churches in our area. There are a couple of wonderful ministries that we work with. One is called Fresh Hope and the other one’s called Mental Health Grace Alliance. Where there are now networks like hundreds of churches that are doing Christian-based mental health support groups for teens, college students, and adults with mental health issues and support for their families.

And so, I mean, it’s just wonderful to see the way that like the resources are exploding. And, and I think that it helps that there probably enough folks on staff at churches with personal experience of this firsthand. That they get how it can be an issue for other people.

Carrie: I love that. I love that because what you said about. Some things being said from the pulpit or from the stage, it gives permission for everyone else to talk about it. And if we don’t talk about these things in the church, it just makes us feel like, okay, well we just, we just don’t talk about that here. It’s kinda like parents when they don’t talk to their kids about sex.

It’s just kind of like, well, that’s a taboo subject, I guess that’s off the table. And we don’t realize a lot of times how impactful that is. And especially because too often, we put people in leadership on pedestal pedestals and think they don’t have any problems, but they have problems too just like everyone else.

They have struggle and sin and things that God’s working on in their life. It’s so powerful when we’re able to have authentic vulnerability in the church. And I hate that so many times there’s too many barriers to respite to be able to do that. But it’s life-changing when that happens in a positive and healthy way. Too many of these things that you listed and this, the seven things, really keep us from being able to connect in community with other believers, the way that God has designed us to be in community and to stay connected and to grow closer to God and grow closer to each other.

Tell us about a little bit about your book, the Mental Health and the Church. 

Dr. Steve: Okay. So mental health of the church is basically sort of the detailed version of our inclusion model that we share with churches. The first part of that, we talk about that there are seven specific barriers that oftentimes make it more difficult for families and individuals impacted by mental health illness. 

We also give them seven. We also give them seven specific strategies or ways that they can like, think about how they might think about like responding. And so that, so that some of the things that are like really essential would be like having the church commit.

That they’re going to do an inclusion plan and that there’d be some education of the leaders of the church. The second has to do with the little acronym is teacher. So the first is setting up an inclusion team. The second is looking at sort of the ministry environments or the nature of the physical spaces in which ministry takes place.

So are there ways of making them more sensory-friendly? Are there ways, for example, to design we’re involved with a church where we were like helping them redo their middle school and high school ministry area so that kids who have attention issues would take away more from the teaching and the experiences that they have?

A stands for focusing on activities that are most essential to spiritual growth. So that if you want folks to be in part in a small group, it’s very important to train the leaders of your small groups, in terms of like how you welcome someone who might have issues with anxiety or someone who might be withdrawn because they’re struggling a little at that point in time with the exacerbation of depression.

C has to do with the communication strategy we touched on. H has to do with offering practical helps that in the Lifeway study. 

One of the largest disconnects between what pastors believed about their churches and what family said about their churches was that most pastors believed that their church had a current list of mental health facilities and professionals that they could refer people to. But 70% of families said that that wasn’t the case. One of the things that like the church that I go to does is that before COVID we had large respite events where we would have like 85 kids at the church on a Friday night. And probably the majority of them had a primary mental health issue, where again, the parents were able to get an evening out and then.

Our most popular blog post a couple of years ago was entitled, We had no casseroles. And it was about 60 minutes segment that was done, where they were talking about the struggles that parents in Virginia were having like the teens and young adults getting mental health service. And so the whoever from 60 minutes was interviewing the one mom and she goes, “You know, when our 13-year-old daughter broke her leg in a skiing accident and was in the hospital for a week for surgery every single night, somebody from our church brought us food. Six months later, when she overdosed and was on a psychiatric ward of the local hospital, we had no casseroles.” And so like, why do we, as the church think about like treating those things so differently.

So what are some practical things that we can do to help them? There is education and support, offering like a fresh hope group, offering like a grace group through Mental Health Grace Alliance, having NAMI doing their education and family support groups, making sure that the folks who are in leadership positions in the church get the training they need to understand.

And then our has to do with releasing your people for ministry. For this to work, folks on staff at churches have so much on their plate that they’re overwhelmed that the people need to take ownership of this because God has positioned all of us in terms of where we work, where we go to school in our neighborhoods. We all know people who struggle with.

And I actually think the best inclusion plan is having a trusted friend coming alongside you the first few times that you go to a church. Who can help to navigate the overly exuberant door greeters and some of the other challenges and help their friends and help their loved ones to be able to navigate some of the things that might make them a little more uncomfortable.

Carrie: Yeah, that’s good. That’s really good. I think all of this information is really helpful and I’m glad that you started this ministry and God put it on your heart because I’m sure it’s grown and there continues to be a need for it as more churches are becoming open to how can we include all people.

As we’re winding down towards the end here, at the end of every podcast I like our guests to share a story of hope, which is a time in which you received hope from God or another person. 

Dr. Steve: Well, I think that the thing that brings me the most hope is seeing the way some of the churches that we serve and other like-minded ministry servers are embracing and understanding this cause. That when we started doing this, there, I mean, there’s literally nothing out there that we have a group that we moderate for mental health inclusion, ministry leaders that not as several hundred members. We’re seeing churches implement plans and we’re seeing them welcome more people.

We’re into the hundreds now in terms of churches that are hosting Grace groups and, and, and, and, and hosting fresh hope groups. And when we get invited to like different conferences and have the opportunity to train, there are more people signing up for this mental health stuff than for any of the other things on the program, but these conferences.

And so it’s really encouraging that after a very long time when we see churches get it. I was at a very large church, training over 200 volunteers, one weekend it’s a church people would be familiar with that was very interested in doing this. And so I stayed for worship on Sunday and it was interesting because the lead pastor wasn’t there, but he knew what was going on. At the beginning of the worship service, he starts it off by saying “I’d like to start by praying for anyone who’s with us today who might be struggling with depression.” He didn’t have to do a whole sermon on it, but simply by doing, just simply by saying something like that the folks who were there that day, who may have been wrestling with stuff knew that they would be welcome and knew that it was okay to talk about.

Carrie: That’s good. That is very hopeful. Thank you for coming on and sharing your wisdom. And I’ll put all the links in the show notes to Key Ministries and the book and how people can get in contact with you. 

Dr Steve: Well, yeah, that would be awesome. And you know, I’d like to get together and say, hello. My daughter goes to Belmont University in Nashville, and she’s hoping to become a psychologist.

We have issues with anxiety and depression and things like that. So, I do get a chance to be in your neck of the woods fairly often. Ms. Carrie. 

Carrie: You’re welcome to sit down with me for lunch anytime. We’ll get together. 

Dr Steve: I’ll look forward to it. Thank you. 

_______________________________

My hope really for this episode is for people to share this type of information with their pastor or ministry leaders, small group leaders, children’s ministry leaders.

Your church really may not know that this help and support is available. And so this episode may be an open door for you to start to talk with the people in your congregation about some of your own mental health struggles. So, if it helps to share the episode with them and say, Hey, sometimes this is my experience at church.

I hope that this episode helps you do that as well. So I promised for our 25th episode that I would be giving something away and I am, I am giving a $25 Amazon gift card away to one of our email subscribers. So if you’re saying, “Carrie, how do I get on the email list?” It’s super easy. You go to www.hopeforanxietyandocd.com.

There’ll be a box up at the top where you can put in your name, and your email address, and then you will automatically get a free relaxation download. It’s something that I use with clients that people have found particularly helpful. You have two weeks to become a subscriber to qualify for the Amazon gift card.

And I will be letting the winner know by email and also posting about it on Facebook and Instagram as always. Thank you so much for listening. 

Hope for anxiety and OCD is a production of By The Well Counseling in Smyrna, Tennessee. Our original music is by Brandon Mangrum and audio editing is completed Benjamin Bynam. Until next time.  May be comforted by God’s geat love for you.

20. Overcoming Sexual Anxiety and Dysfunction For Women with Kelly Ehlert, PT

Written by Carrie Bock on . Posted in Anxiety, Podcast Episode. No Comments on 20. Overcoming Sexual Anxiety and Dysfunction For Women with Kelly Ehlert, PT

Discussion with Kelly Ehlert, PT, DPT, OCD, COMT, CDNT. Kelly is a Pelvic Floor Physical Therapist who works with women experiencing pain during sex. Kelly also opens up about the issues she experienced after giving birth to her daughter.  

  • Different messages about sex that can trip women up (moral, medical, media)
  • Common sexual issues in women
  • What is pelvic floor physical therapy and how can it help women?
  • Connection between stress (fight/flight/freeze response) and desire
  • Why we’re all normal in our own way

Kelly’s PT practice: Priority Physical Therapy
Book: Come as You Are

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Transcript of Episode 20

Hope for Anxiety and OCD, episode 20. If this is your first time with us, we are all about reducing shame, increasing hope, and developing healthier connections with God and others. You can find us online anytime www.hopeforanxietyandocd.com. 

Today’s show has a special disclaimer that it may be distressing for some listeners and if you have little ears listening you may want to stop the recording and pick this up at another time when there aren’t children in the room. I have an interview to share with you that I did with Kelly Ehlert. We talk about something that I believe the church doesn’t talk enough about and that is sex. 

Sex is an amazing and wonderful thing, but a lot of times there are mixed up messages that we receive from a variety of sources. We’re going to talk about those on the show, and we’re also going to talk about sexual dysfunction for women specifically. What happens when things go wrong in the bedroom? What do you do about it? How to get help and hope for these situations. Kelly was open enough to share some of her personal story which I think just adds to what she does professionally, which we’ll get to a little bit later. So let’s dive into the interview. 

Carrie: Today on the show, we have Kelly Ehlert, and we’re going to get into what you do a little bit later. We’re going to maybe leave people in suspense for just a little bit to have this conversation about some of the messages that we receive in the media about sex through watching TVs and movies, but also in the church. Some of the conversations surrounding sex and baggage that women specifically can have from some of those messages and also experiences with sex maybe that weren’t positive because not everybody has a stellar, positive experience with sex.

Do you want to talk a little bit, maybe about your background or your experience like in the church, just in general and then surrounding these messages? 

Kelly: Yeah, thanks for having me. I grew up really conservative. I grew up at Church of Christ. I grew up outside of DC, so not quite the Bible belt but where sex was off the table. You did not do that till you got married. I heard things on the bus and behind the bleachers. You hear all sorts of things I don’t think I quite understood until later. I will say my mom was a nurse and I remember asking her about a blow job and why would somebody like that. I remember asking things, I don’t think I felt particularly shameful, but I also didn’t know what to ask or why certain things were. I went to Lipscomb. My husband and I met and we waited to get married. A lot of his background I think was the same. You meet, you wait, and then you figure it out when you get married. It’s kind of what we were joking about. We’re supposed to know what we do once we get married. There’s some magical thing that happens and your brain and your body know exactly what to do and in reality, it’s kind of a learned thing. Some of it to Nate there’s arousal, and there’s a certain procedure that your body goes through, but I think as women, ours depends on context a lot more than I think we realized.

Carrie: I think my messages were similar. I had messages in the church that were no, no, no until you get married and then somehow when you get married, it’s kind of like, “well, you know, sex is good.” All of a sudden this whole thing that I built up this idea around that maybe it was bad or shameful, or just not even knowing what to expect. And then all of a sudden it’s like, “woohoo” your wedding night’s supposed to be amazing and everything they’re following. And I had a really hard time in my first marriage trying to make that shift and switch of even seeing myself as a sexual being. I didn’t. And then from the school system, there was a lot of fear messages around sex and a lot of anxiety, like you could get an STD, you can get pregnant, something awful is going to happen to you if you have sex. So there was not really a lot of positive lingo about some of the things that we want to talk about, like God created us, women and men, as sexual beings. I had someone tell me when I was newly married, they said,” yeah, our parents talk about sex was kind of Adam and Eve figured it out and you can too.”

Kelly: And there’s so much more than that. It should be so much more and I think opening the conversation up earlier with your partner, your spouse rather than later is more beneficial. We have to be enlightened to the idea that communication needs to happen. I think we just assume. We put our assumptions on them when you know my husband and I’ve talked through quite a bit, I’m a physical therapist and we’ll get into some more of that, but I had a lot of issues after I had my daughter and there were several things that, the things that I didn’t like about myself, he had to tell me, “Kelly, I don’t care” or “I still love you despite that.” So I think a lot of the things kind of what I said a minute ago about the context is we sabotage ourselves, assuming that what we don’t like about ourselves is something that they pick apart when in reality that may be something they enjoy about us, or it may be something they don’t even think about.

Carrie: It’s not like even on the radar, one of the things that bothers me about movies and TV shows is there’s this idea or this message that you can just hop into bed with anyone at any old time and have great, amazing sex. It doesn’t matter if you haven’t known them before today, you can have amazing sex that evening, and you’re all wrapped up in the sheets and it’s wonderful. I think that puts a lot of pressure on people to feel like, okay, so then what happens if it doesn’t work that way? For me, what happens if I start to, maybe there’s something wrong with me that I’m not able to do this thing that I feel like everybody else is engaging in and they’re having a pleasurable experience. So let’s talk a little bit about some of the common sexual issues that women face. 

Kelly: Okay. I guess in my field, when I get folks is more postpartum, because I think that’s when people around that area, even if it was an area that was very secluded, you have a baby and all of a sudden everybody’s messing with your stuff.

And so it makes it okay to, to kind of get things checked. So generally I see postpartum pain with intercourse, either penetration, just that initial touch and even deeper. I’ve had some it’s called vaginismus where it’s like the vaginal canal and even everything around it, it’s almost like it shrinks up or tightens up. So anything around that region that whole vulvar region gets super sensitive to touch and a lot of it’s kind of mental with it too, because the body knows it’s going to hurt. So if anybody messes with anything or even just sitting the body tends to cringe and further feed into that. So we’ve got to work usually with one of you guys, a counselor to work through some of the why. And I’ve seen fractured tailbones postpartum where the pelvic floor is attached to the tailbone and it hurts with intercourse that way. I guess mainly kind of to answer your question, I see a lot more pain-driven issues and then the causes can be different, but there can also be a lack of orgasm if the pelvic floor is really, really weak and orgasm is just a contraction of the pelvic floor. So there’s less sensation. The less sense of you that feels good and so if it doesn’t feel good, then why do it? And we kind of go down that rabbit hole, but I’d say the biggest factor and what statistically we see is just a lack of desire due to stress. Your body’s chased by a lion all day long. I wouldn’t want to have sex, but it’s still in that stress mode. And I think all of us can identify with that over the last year where we’re just not in our typical state of mind and workplace. 

Carrie: So tell us a little bit about what you do and then we’ll talk a little bit further about those responses in the body.

Kelly: As a physical therapist, my background is an orthopedic physical therapist. I’m board certified in that. So anything neck, backs, jaws, shoulders, any kind of joint, but then also with my kids, I went down the women’s health path. So that’s an extra coursework to look at the internal aspect of the pelvic floor and the pelvic floor is just the insides of your pelvis. So it’s the muscles that help control your pee and your poo.

It’s the muscles that allow you to have pleasure with sexual intercourse or anything around that. It’s the muscles that help stabilize your pelvis and it’s the group of muscles that also help you kind of support all your organs up and in. So this part of our body, I never realized how important it was.

And I think it’s just a part of our body that I appreciate a lot more after having kids. But when you realize what it does for us, it’s amazing. You don’t realize when something is working well, how much it does until it stops working and you start noticing leaking or pain or heaviness or issues with jumping, that kind of stuff.

Carrie: That makes a lot of, a lot of sense. So do you usually get referrals from say OB-GYN who know that their patients are having issues and they would benefit from pelvic floor physical therapy? 

Kelly: Most recently, I started off more cash pay model. We’re starting to delve into some of the insurance, but most of my clients find me through word of mouth. I have very few referring practitioners. If they are then it’s Kairos and Pilates and massage therapists because they’re dealing with that population. And honestly, a lot of us, I think our generation, the thirties and below are a lot more proactive, so there’s a lot more looking and searching. And this topic, this conversation is way less taboo than the generations prior to us. So I think most of my ladies have found me because they’ve asked questions or they’re on Instagram. So, yes and no. I would say a lot more word of mouth in the last six, eight months span like general providers, like orthopedists and that kind of thing because I am a smaller practictioner but yes, that in the bigger groups, that’s where they get a lot of their clients.

Carrie: How do people know if they might be a good candidate for this type of therapy? 

Kelly: So there’s actually a really good screen that I have on my website. Anything from pain with prolonged sitting, sciatica pain with intercourse, like we mentioned, any leakage, even like abdominal pain and discomfort.

If you have constipation, all that pertains to the women’s health, physical therapy world. Issues with breathing. Any abdominal surgery, I think would be good because what we’re finding is there’s a high correlation with abdominal surgeries even abdominoplasties that scar can add here down. And we get, I think it’s like as high as 40% chance of bladder irritation, like bladder issues and then bowel obstructions.

So there’s a wide plethora of things that we kind of see and work on. 

Carrie: Yeah, let’s kind of circle back to that. Talking about the nervous system response and this stress response that keeps us perhaps out of desire, I guess, is what you were saying like if we’re really ramped up, it’s hard for us to have a desire to engage sexually.

Kelly: I guess the best, I’m gonna bring this book up. You guys can’t see it, but there’s a book called Come As You Are by Emily Nagoski can never say her name and it’s almost 400 pages that she really talks a lot of levels on, one, know your anatomy, which is probably the biggest thing being on this side of it is if you don’t know yourself how are you going to expect somebody else to know you too.

That’s kind of first and foremost, but she talks a lot about the stress cycle and how we, how we either feed into it or how we can work out of it when your body is in that constant fight flight or freeze, or if it’s had a trauma and that’s more what’s your kind of world is, I feel like you can probably speak more to that.

Whether you recognize it or not, the body holds that trauma, or there’s usually something mechanical that occurs whether you consciously or subconsciously recognize that feeds in. So when you’re in that constant stress node, your body’s in fight that fight flight or freeze your body is in survival mode. It doesn’t need to procreate. It needs to survive. Like you said, the last thing we need is to go have an intimate moment. Now for some 10 to 20%, according to Emily’s book, that actually derives sex, like that’s a turn on for them where the rest of us, the 80, the 90% of us, that’s a turnoff when our brain is busy, we’re on that hamster wheel we can’t kind of actively, maybe enjoy and participate as much. And as a female, that’s really what there is no pink viagra because we are so context dependent. we need the sounds. We need the smells. We need the kids in bed. We need to be loved like we need all these things usually in order for that switch to really go off.

And she has a really cool worksheet in there on figuring out what turns your brakes on and what turns your kind of your accelerator on and stress for most of us is a really big break step around or where it just. Your system just dies down and that’s the last thing it kinda needs. You’ve just got to figure out how to break that cycle.

Carrie: That’s interesting because I have had women say, well, I just don’t want to, but they have a hard time maybe even being aware we’re breaking down some of these different aspects of things that keep them in that fight flight or freeze mode or they’re so used to just living in that heightened state. And I don’t know what your experience has been, but I don’t think it always has to be a sexual trauma to cause these types of dysfunctions, it can be other types of situations that were maybe chaotic in your family growing up that leads you to be in that state and that may affect you sexually.

Kelly: Even just your assumptions, kind of going back to our conversation about maybe our preconceived notions. In her book, she talks a lot about gardens like your sexuality is your garden and our society and our culture and our family puts all these little weeds in there and we have to figure out what within that garden is truly what we believe in what was planted there by however we live and whatever we live. And so I wrote this down because it kind of helps me, I guess, break things down and help me identify personally, and then professionally where I believe. So she talks a lot about there’s three types of messages, there’s moral, a medical message, and the media message. And so kind of going back to what you said is that doesn’t matter where you are, just identifying I think what your beliefs are is huge. So she talked about one of the moral messages being were damaged goods like if you have sex or you like it and you lose your virginity, then you’ve lost all value. Maybe a century-old mindset of once you give yourself away, nobody else is gonna want you. You just need to accommodate your partner. I’ve watched a movie on Netflix, it’s kind of their whole role in society is to appease the male and make him feel good. It has nothing to do with what the female’s body is wanting to do. You just check that box.  And the other one is the medical model where you can cause damaged goods. Like you said, you can cause STDs and you can cause pregnancy. And it’s just very medical where you get this, then this, then you get aroused and you ejaculate and then you’re done, but there’s no emotion. And then the third message is around the media where you’re inadequate. You don’t know what you’re doing. If you don’t know 15 different ways to have an orgasm or 15 different positions in which feels good to you and your partner. You’re too fat. You’re too skinny.

There’s all these little messages that feed in too. I think what we, once again, we sometimes can sabotage ourselves. I think we take the enjoyment out of it because we assume that I shouldn’t enjoy it. It should be for him or society says, if I enjoy it, I must let, like, we put these names to it, but why is that?

And I don’t know. I don’t know the answer, I think just identifying the thought, maybe important in the beginning,

Carrie: I think a lot of times we don’t evaluate the messaging has been and so then if we have negative messaging, it’s important for us to say, “what am I putting in that’s different into my mind?” And hopefully something like this is a start to that to help people evaluate. What is it that I really believe about sex? What have I taken from the media from morally, from the church, from my family, from the kids behind the bleachers? And some of that information is way off of where we need to be.

I’m curious for you, how you shifted your thought process maybe on sex or had a more positive view of sex? 

Kelly: So definitely more of a personal conversation, but I think a lot of it is going through that book. I had a lot of pain after my daughter with intercourse and telling my husband, “no.” Being able to say no, gave me more power than I think I realized I had. But then I remember asking the doctor about it and she’s like, ”Oh, well that’s just typical rub some cream on it.” And that was eight, 10 years ago before I think the pelvic health world became so popularized, I guess in the last four to five years, I would hope in the next five years, we’re the first line of defense for postpartum. They clear you and then you come to see us for anything else. But I think being able to shift that mindset of it doesn’t have to be penis and vagina intimacy. It can be anything else like sex doesn’t always have to be, and you don’t have to necessarily get off. Being able to talk through, “I just don’t want it tonight” because I think I went a long time with it. Well, he needs to initiate it like that’s just the man’s role. He needs to want it in order for me to be okay with it. And you know, I have another couple of stats here, but 30% of people are responsive,

My husband comes to me 30% of the time I respond to that, only 15% of us are like spontaneous, where it’s like, “Oh, I want sex like, let’s go get him the rest of us.” They’re like, “Oh, I kind of want it. Oh, but he’s there.” But it’s a combo of the situation. I think for me recognizing that he wants me to want him, like he likes that pursuit as well.

And massaging is good like touch. Just being able to be okay with not just jumping into bed. And maybe I was just super, super rigid in my beliefs, and it was like, you give him what he needs and get out and go rinse off. We’ve been able to talk through some stuff and then being maybe more, let’s say, more experimental, whatever, but being more open with trying different things.

Carrie: I always tell clients, and I’m curious if you agree with this from the medical side of your work. I really believe that great sex requires great communication. I mean, you have to be able to have those conversations, even if they’re hard, or even if they’re uncomfortable to be able to say, “Hey, when you do this, that feels good.” Even just language that we use in the bedroom. I like this type of wording and not that type of wording or these are some things that would be helpful for me to hear from you.” And if you’re not able to have those conversations with your partner. I just don’t think that you’re going to be able to have this expectation that it’s going to be great if you’re not able to communicate and talk about what you enjoy because different people obviously enjoy different things.

Kelly: Yeah, and that was one of my big takeaways from that book too, is everybody is normal within their own realm. We all have similar anatomy. We all have similar kinds of patterns. Anatomically we go through this typical pattern of arousal on through, but we have different things that turn us on and turn us off.

And you can’t expect your spouse or partner to know that If you don’t tell them, “Hey, when you do that, that was good. Do that again,” They have to be told that like a little kid, like they go by your vibes in your words and so the words aren’t present, then you’re not validating them or yourself.

Carrie: Where do people start If they are noticing they’re having sex maybe less and less often? And that might be a warning sign for them or what would be kind of like a good first step if they feel like their sexual relationships declining? 

Kelly: I guess it would be kind of like you were saying as self-assess it. It’s situational because something else has taken that place in terms of time or the stress. There are specific sex therapists out there. I have one friend that I will refer folks to, but I don’t have anybody specific, so that may be better. I’m in kind of stepping back to say, well, I noticed this and figure out. I always like finding the why with everything within the therapy world. It’s I can work your neck out, but if it’s going to come back because you’re pastorally not correcting it, then kind of the same with this it’s I think backtracking to is it because I just had a baby and everything hurts? Is it because your kids just stressed you out and you had to go pull them out of jail and you’re in that fight-flight or freeze? Is it just because you’re tired? Isn’t it hormonal? What’s driving the bus and then from there it will be either probably finding the right practitioner to guide you in that direction.

Sometimes it’s talk therapy. Sometimes it’s an OB-GYN or somebody that can give you a hormone replacement. 

Carrie: I think it’s really important in these types of situations where this can happen for a lot of different areas, but specific sexually, there may be some medical components involved and then there may be some psychological components involved. And when we’re looking at the situation, it’s hard to assess what’s medical and what’s psychological. I think it’s important for the medical community and the counseling community to really work together for us to be able to say, Hey, maybe you need to follow up with a women’s clinic or with your OB-GYN about that.

And for the medical community to say, Hey, has there been any trauma in your past, is there anything that’s been unaddressed that you feel like could be contributing to this issue?” Or do you just need some skills to learn how to calm your body down to like learn how to wind down at the end of the day?

We’re running 90 to nothing too often and so really learning those skills is a good process. 

Kelly: I agree with that. I have a lot of patients that I’ll suggest things to, but nothing is going to change unless you actually try some things and the consistency, a little goes a long way. So being consistent with whatever you’re trying, give it enough time. Going back to your medical model, there’s some skin issues that can cause pelvic floor dysfunction, but that can, the skin issues can turn into cancer. So for me, being able to recognize, “Hey, this is not something that’s within my scope.

You need to go see some, you know, somebody beyond a therapist or a PT. You need to go get some medical treatments.” I think I would say most of us hopefully are able to determine some of that. We got to get a gut feeling in terms of when things are not going right. 

Carrie: But what is a usual treatment length for someone that receives, um, pelvic floor physical therapy?

How long does it take somebody to go through therapy? It’s probably similar. It depends a lot on the situation. 

Kelly: I would say most. So if it’s more of an incontinent. Let’s say the pelvic floor is influenced by your GI system, your endocrine system, your skin, musculoskeletal your integument. It has so many systems that cross up in, and then through that, I find that part of our body to be slower to learn than like a shoulder or neck or something that you can physically see because there are so many other little factors that go in. I usually say two to three months for kind of some of the women’s health issues.

If it’s postpartum, I’ll encourage them, a year and a half to two years for you to get back to normal, to feel normal. Not that they’re with me the whole time, but just giving them that timeline of kind of biological tissue healing, that kind of stuff. But it also does depend on do you need some psychological help. Can I physically help you here and I show you how to mechanically help your body move better but every time you’re stressed it feeds back in how do we take that stressor away or help you recognize when you feed in and in that talk therapy, I’m the catalyst and I see you a month or two, and then you go see somebody else and come back and we revisit or see a doctor. There’s a clinic in downtown Nashville called the WISH Clinic (Women’s Institute for Sexual Health) and they do quite a bit. They do pelvic floor botox, injections, trigger point injections. I’ve actually trigger point dry needled the pelvic floor. They do vaginal suppositories with valium for kind of decreasing. There’s a lot of options. 

Carrie: That’s really good for people to know. I mean, even if people have had problems in the past that they find reoccurring that the growth in treatment options in this area, like you were saying has probably grown exponentially in the last five or so years. I didn’t know that they were using things like botox for that.

Kelly:  Yeah, I’ve got a client right now who had endometriosis then a hysterectomy and everything just got locked up in response to I think the surgery and then all the pain prior. I’ve needled her and we’ve done some really cool stuff in terms of getting her pelvis moving. But she’s done the botox. She’s like 90, 95% better. Now it’s taken us a couple of months because it’s been a couple of year’s worth of issues we’re having to kind of delve through, but they’re phenomenal. And that just knowing the options that are on the table besides just don’t do not let somebody cut something out because it hurts that does not answer all the questions. If you have abdominal pain, do not let them do a hysterectomy without ruling out endometriosis and some of those other triggers or even pelvic floor tone can increase abdominal pain because it irritates blot like there’s so many overlapping things.

If nothing else, do not let them cut on you because scar tissue creates more pain and more attention and more adhesions like, “Can we just go down that cycle?” 

Carrie: That’s really good because I think doctors are just kind of like doing their best and it’s like, well, here’s an option and there’s an option and maybe we should do this. And you go down this rabbit hole sometimes of things that like you were saying potentially may cause more problems than what you had to begin with. But I guess the message that I would want people to take away from the totality of this conversation is if you’re having issues with pain during intercourse, Hey know that you’re not alone, that other women are facing these types of issues. People aren’t talking about it. So you may feel really alone, but these are relatively common things that you see in your practice that I saw in my practice and that there is hope, and there is help and keep knocking on the doors until you get the help that you need.

Go to therapy. See how that does or go to your doctor, talk with them. Talk with them about all the different treatment options that are there for you and ask questions and keep going until you find somebody that can help you. You may not find that person on the first or second try, but you may find them, the third person that you talked to.

So keep it hopeful. I guess from a spiritual, Christian perspective, I’m curious maybe some of your thoughts about that as far as what would you tell a Christian woman who’s struggling with these types of issues?

Kelly: I have a nine-year-old and I’ve been trying to figure out how do I give her the message of your body is beautiful. God created it just for you.

You need to keep it holy like keep it to yourself, but at the same time how do I get her to understand that? She needs to know what it is like. It’s okay to look at yourself. It’s okay. That is your body. You only get one. Kind of what I said earlier is if you don’t know it, you can expect somebody else to either that getting comfortable with your anatomy. Just knowing the difference between a vulva, vagina the canal, the vulva, that whole region and knowing where your pee comes out, where your poop comes out. Knowing you have three holes down there. Knowing just what things are. And I don’t think there should be shame around touching. Guys play, I mean, my son’s do that. He pulls off on that thing all night. Well, what I’m saying that it’s acceptable. Kind of going back to the societal, men are supposed to get off and we’re just supposed to help them. I think we need to have pleasure too and we need to, I don’t know the best answer like I don’t think that masturbation is bad.

I think that’s a message that I have to personally figure out how to communicate with my daughter. That’s something my husband and I have talked about in terms of what I like and what he likes and are we okay doing separate things? Do we want that to be like, that just needs to be a conversation piece within the relationship.

If you’re single, I think it’s fine to explore. You’re not denying. The Bible talks about not denying your partner and not saying being consensual, but not denying your partner there that pleasure. I can’t think of the verse, but something to that extent. And so that’s still a grey area and I don’t have a good answer for you. 

Carrie: Yeah, I think this sense of we were created uniquely by God with a purpose and God created us as physical beings as emotional beings, as sexual beings, as spiritual beings and somehow that’s all wrapped up in the same body and we have to figure out how those pieces in our work with each other. I do believe that sex is a spiritual connection when you’re married between you and your spouse and that’s a picture of our connection and our union with Christ and the church, and something really sacred and valuable and holy about sex. And yet at the same time, It doesn’t always work the way. it’s supposed to because we’re humans and our bodies are flawed and sometimes we go through surgery or childbirth and sometimes things don’t work the way they’re supposed to.

And knowing that, that doesn’t make you like, “Oh gosh, I’ve got this horrible thing wrong with me and I need to have a bunch of shame about it.” 

Kelly: You’re not letting this dysfunction define you. Acknowledging it and knowing you were meant for more.

Carrie: Yeah, and kind of like keep pursuing that journey until that your sex is restored in your marriage and relationship. I think that there’s hope there. 

Kelly: When you look through in Song of Solomon, I mean, he talks about her breasts. God let that be and God allowed that to be in that special and I think part of that is skewed I think, with how we grew up in terms of that, that gets twisted and it shouldn’t be that way, but my husband’s words are God made it and it’s not dirty if God made it that way. 

Carrie: Thank you for sharing some really valuable information. Today I feel like there’s so much that we could go into and really just like we’re able to scratch the surface on things, but I hope that it will be kind of a springboard for people to maybe go get more education or look into some different avenues. 

So since this podcast is called hope for anxiety and OCD at the end of every episode, I like to ask our guests to share a story of hope, a time that you received hope from God or another person. 

Kelly: Sure, I guess kind of what got me into this field, in general, was issues after my daughter and so in terms of that riff between me and my spouse since we’re on this topic, I couldn’t enjoy him. I remember laying in the bed crying and then going like being able to go through courses to help my clients actually helped. It did more, I guess. You kind of grow as your professional relationships with your clients grow. I think that’s why I am like, sex is better because that communication had to occur.

And I was able to mechanically in my brain, went through the coursework, was like, well, that’s why that hurts because this is scarred down and for my brain, I needed the biomechanical. I need somebody to explain it to me on my level that I could. It didn’t hurt just because I had a baby, it hurt because I had scar tissue because of muscle tore and every time he went through that spot, it made it tear more. That made sense to me and I think just being able to break things down on my level gave me that ability to be like, okay, I can do something about this. This is my body. I know how to help myself and that led me down the path of all right now I have a second kid, I want to do this for other moms. I don’t want them to lay in the bed being miserable, dreading, “Oh my gosh, he’s coming. Is he going to want it tonight? Am I going to just cry again?” I want to enjoy sex. I want my partner to enjoy me. I want it to be consensual.

I want to go on a date and come home and be ravenous like the movie. Like I want it to be that way and I want my clients and my patients to be able to understand that it can. It can be that way like there’s my hope.

Carrie: That’s how empowering just to have that knowledge about your own body and why it was responding, the way that it was, and then realizing it, doesn’t always have to be this way and I can get some help and help myself and move forward.

Kelly: That’s far back in your lap and understanding. I just think like you said, keep searching. Be your own advocate. If you don’t think something’s right, we have that good gut-fixed sense as women. I think we just have something, some intuitive, something innately in us that helps us help each other, but also help ourselves. Our body wants to thrive too.

We want that homeostasis, I guess. Keep searching. If you’re getting the runaround and help, there’s a ton of us out there on social media now, that you see something you can go down that path and search a little harder.

Carrie: We’ll put links on your information in the show notes and as well as for the book that you talked about too. Thank you so much for sharing today. 

Kelly: Thank you. I appreciate your time. 

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There were so many good nuggets in that interview and I hope it sparks some further thought in conversation in your mind, if you’re a woman about how can I make my sex life better for myself and for my spouse.

Do you have lingering questions from either this episode or other episodes that we’ve done on the show? If you are leaving with unanswered questions or feel like you want to know more about a specific issue I would love to hear your feedback on the show because I want to make it something that you want to continue to come listen to. So you can drop me a line anytime through our website hopeforanxietyandocd.com and I promise to read those and respond to you. Thanks so much for listening. 

Hope for anxiety and OCD is a production of By The Well Counseling in Smyrna, Tennessee. Our original music is by Brandon Mangrum and audio editing is completed by Benjamin Bynam.

Until next time. May you be comforted by God’s great love for you.