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Group Therapy Really Works with Pegah Mollahajian & Dr. Taube-Schiff

Episode 56|38:03 min|

Podcast Categories: Cognitive Behavioural Therapy, Treatment, Young People,

#OurAnxietyStories – The Anxiety Canada Podcast
#OurAnxietyStories – The Anxiety Canada Podcast
Group Therapy Really Works with Pegah Mollahajian & Dr. Taube-Schiff
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Dealing with anxiety or finding strategies for anxiety is tough at any age, but how can you manage anxiety as an adult when you didn’t have access to the right resources as a child? 

In this episode of #OurAnxietyStories, Anxiety Canada Youth Network alum Pegah Mollahajian shares her story, and registered psychologist Dr. Marlene Taube-Schiff offers her clinical expertise and insights into group therapy, exposure therapy, cognitive behavioural therapy (CBT), and more.  

At 25, Pegah reflects on being an anxious child. As a young Iranian Canadian, she felt her family did not know how to track down the right anxiety resources “at the right time.” Dr. Taube-Schiff confirms that anxiety disorders often appear at a young age and go underdiagnosed, adding that early intervention is important but we can still treat adult anxiety. When Pegah looks back, she feels her anxiety prevented her from many new childhood experiences and wonders what could have been if she’d had the right treatment. Dr. Taube-Schiff stresses that when anxiety hits during formative, developmental years, it can seemingly interrupt our lives and personal growth, but we can see getting better as a real opportunity to move forward. Though Pegah had no formal anxiety treatment or strategies as a child, she found ways to cope as an adult. When Pegah’s anxiety re-emerged in university, she began to push herself out of her comfort zone—something Dr. Taube-Schiff notes could be considered “informally” engaging in exposure therapy. 

Eventually, Pegah found Anxiety Canada’s MindShift CBT Groups, an 8-session online group therapy program for small groups of adults (aged 19+) with mild to moderate anxiety. Since participating in MindShift CBT Groups, Pegah has learned to analyze, challenge, and balance her anxious thoughts. Dr. Taube-Schiff and host John Bateman also touch on the benefits of group therapy: it not only offers the same content and skills as individualized therapy, but participants can find comfort in connecting with others, realizing their similar worries and symptoms, and knowing they’re not alone.  

This episode touches on how important it is to connect families with the resources they need. FamilySmart’s ‘In the Know’ videos and events provide expert speakers on topics important to young people, families, and those working to support the mental health of children and youth. For more information, visit www.familysmart.ca. 

About the Guests  

Pegah Mollahajian is young adult who recently completed her master’s degree in public health at the University of Toronto. As an Iranian Canadian child, she experienced anxiety but didn’t have the resources to understand what it was or how to cope with it. After receiving help from Anxiety Canada’s MindShift Program, she applied her new understanding of anxiety and desire to advocate for mental health by joining the Anxiety Canada Youth Network for the 2021-22 season.  

Dr. Marlene Taube-Schiff, a registered psychologist for over 15 years, offers her expertise and shares insights with Pegah and John. Dr. Taube-Schiff’s clinical work is focused on the delivery of scientifically supported treatments for obsessive compulsive and related disorders, anxiety disorders, depression-related issues, and a wide range of emotional and behavioural problems. 

"[MindShift CBT Groups] was the biggest turning point in my anxiety journey. And I will be forever grateful to Anxiety Canada for those courses because it was the first time that I didn’t have to explain what was happening to me. And also I didn’t have to explain how much it was disrupting my life, that it wasn’t just like stress. "

- Pegah Mollahajian

This podcast is brought to you by Anxiety Canada™, a leader in developing free, online self-help and evidence-based anxiety resources. For more information and resources, please visit our website and download our app, MindShift™ CBT.

Transcript

Intro: This is #OurAnxietyStories, the Anxiety Canada Podcast with John Bateman. This is the place where people from all walks of life share their anxiety stories to remind you that you are not alone. If you have an anxiety story you’d like to share, contact us at AnxietyCanada.com/OurAnxietyStories 

John Bateman: I am John Bateman, and welcome to Our Anxiety Stories, the Anxiety Canada podcast, which can be found at anxietycanada.com/ouranxietystories. My guest today is Pegah Mollahajian. She’s a 25-year-old Iranian Canadian woman who recently completed her master’s degree in public health at the University of Toronto. 

She first experienced anxiety as a child but didn’t necessarily have the agency or resources to understand what it was or how to cope with it. Since accessing more resources and participating in the Anxiety Canada MindShift [CBT] Groups [program], she’s been able to successfully understand, cope with, and challenge her anxiety. She has since joined Anxiety Canada’s Youth Ambassador Team for the 2021-22 season.  

Now joining us for the first time in this podcast, which I’m very excited about, we’re going to have a clinician whose name is Dr. Marlene Taube-Schiff. Dr. Taube-Schiff has been a registered psychologist for over 15 years, and her clinical work is focused on the delivery of scientifically supported treatments for obsessive compulsive and related disorders, anxiety disorders, depression-related issues, as well as a wide range of emotional and behavioural problems. 

Welcome everybody.  

Pegah Mollahajian: Thank you for having me, John. I’m so excited, and it’s so lovely to meet both of you.  

John Bateman: Yeah, I’m excited about this, too. Pegah, we’ll start it out as we always start it out by having you tell us your anxiety.  

Okay, great. So, my anxiety story began when I was pretty young. I think I had my first actual panic attack when I was about seven or eight years old. And the challenge with experiencing anxiety from such a young age is that I didn’t have. The education or vocabulary to tell my family and my peers what I was going through, and that was really tough. It meant I kept a lot of it to myself. And because of that I developed some really strong avoidance behaviours. 

So, I tried to avoid things that I thought might trigger a panic attack, and that really impacted my life. I stopped going to restaurants with my family. I hated eating out. I stopped looking forward to field trips. Basically, leaving the house for me was very difficult as a child and well into my adolescent. 

And once my family kind of picked up on something that was wrong, they took me to many doctor appointments because they assumed that what I had was, a physical issue. Like there was something wrong with me physically. And when that was ruled out, basically they told me that I was experiencing anxiety and unfortunately it didn’t lead to any formal treatment. 

I was still … pretty young, like 10 or 11 years old. And it was really hard. I didn’t really get the support I needed. From what I understand, they hesitate to give children anxiety medication, so that wasn’t really an option either for me at the time anyway. And so basically, I struggled with this well into my adolescence and it got a little bit better when I moved out to university because I was forced to do things that were out of my comfort zone. And I learned that I was going to be okay. So, it got a little bit better. But looking back, because I didn’t receive formal treatment, I did have various moments of relapse even throughout university as a young adult. And I had my biggest relapse during the first year of the pandemic (obviously a very stressful time for everybody). My whole life changed. I moved to a different city. I had to change my job and I thought at that moment that was kind of my breaking point. I thought, “I can’t do this anymore. There has to be something out there that can help me like this. I can’t do this for the rest of my life.” And I stumbled upon the MindShift CBT Groups that Anxiety Canada was offering virtually at the time.  

John Bateman: So, did you just, Sorry, sorry to quickly, did you just, yeah… Did you just find that through an organic search online? Did you search your symptoms or did somebody put you onto that? 

Pegah Mollahajian: I just searched it. It was on the internet. They were advertising it on Instagram at the time, where I first saw it and thought, “Okay, this can’t hurt.” It was very accessible, and it was eight weeks and a group program. I got to meet others and it honestly changed my life. It was the biggest turning point in my anxiety journey. And I will be forever grateful to Anxiety Canada for those courses because it was the first time that I didn’t have to explain what was happening to me. And also, I didn’t have to explain how much it was disrupting my life, that it wasn’t just like stress. 

It was like significantly impacting my life. And they understood that, and they gave me excellent strategies to cope with it. So, that’s a little bit about me and my anxiety journey.  

John Bateman: Yeah. Dr. Taube-Schiff, how common is this in kids nowadays or even, period throughout, the last 30, 40 years? 

Dr. Marlene Taube-Schiff: Well, for sure. I mean, I think, as Pegah’s story highlights so well, things can be very underdiagnosed even though they’re present, and we know that anxiety disorders can appear quite young. Very similar, I think to your story in terms of developing it as a child and it being maintained in some way, kind of off and on, or like kind of waxing and waning throughout one’s adolescence, and then re-emerging in the light of like very significant stressors…we know now for sure early intervention is so important. Pegah, as you were saying like, “I didn’t really have formal treatment. Like, no one offered me these skills and strategies when I was younger.” I’m sure given the way you almost informally were engaging in exposure therapy when you were off university, right? 

Pegah Mollahajian: Yes. 

Dr. Marlene Taube-Schiff: And you were pushing yourself to do things. And I love how you said it. You’re like, “I saw that everything was okay,” which is like the message that we try to help people with in therapy. But to have that motivation to go and try things that are so difficult can sometimes be really hard without some kind of support, be it professional or as you’re mentioning, Anxiety Canada group treatment, peer support, those kinds of things can be very helpful in terms of getting better. 

John Bateman: Yeah, I’m wondering about that, like in terms of… well, I guess one of the things I’d like to kind of look into a little bit, because I was probably around the same age, like maybe 11 or 12, my first panic attack. And before that, I had stomach troubles and I had temper tantrums… So, Pegah like, first you, I’m wondering what kind of, symptoms you experienced, even when you’re that age. What were the physical symptoms that you’re experiencing?  

Pegah Mollahajian: Yeah, that’s a great question, John. I totally relate to the stomach issues. That was the biggest one for me. It was nausea, stomach aches that kind of just were spontaneous and had no… there was no medical reason why I should be experiencing it. Because I did go to the doctor so many times and they were coming up empty handed. A big one for me was racing heart. And I would also get very hot. And I felt like what I would do actually when I was pretty young, I would take ice cubes and put them down my shirt or put it on my face. That was another coping strategy I had that I developed kind of spontaneously. And it helped a little bit, but those were some of the symptoms that I was experiencing.  

John Bateman: Yeah. Well, no kidding. I mean, that sounds like switching your sensory perception over to something else. Is that something that’s common, Marlene, in how people are treated nowadays?  

Dr. Marlene Taube-Schiff: We do consider that to be an effective kind of distress tolerance strategy. So, there is that idea of really dramatically kind of altering your physical state. So, in terms of like literally, I mean you were doing that probably out of desperation the first few times that you did it, right? 

Pegah Mollahajian: Yeah.  

Dr. Marlene Taube-Schiff: But we do actually talk to people [about] using ice cubes, putting them on your skin… allowing your body temperature to come down can actually be very effective in terms of bringing ourselves back to baseline. I live in Toronto, so right now it’s gorgeous out, but we have winter. It gets very cold. When I do see people in the wintertime, sometimes we even talk about opening a window, getting like a cold blast of fresh air. It’s not a long-term strategy by any means, but it can take the edge off when someone feels really dysregulated or that their emotions are totally out of control. And then it gives you that opportunity to figure out like, what do I want to do? 

How do I want to manage that situation? Because when we’re in that zone where our emotions have really just run away from us, it’s very difficult to think straight, to make decisions that we want to make, to push ourselves in ways that we want. So, we need some of those distress tolerance strategies as well. 

The fact that you found them on your own, I think again, is another testament to how you were looking for ways to be able to push through what unfortunately people weren’t giving you strategies for.  

John Bateman: When I first went through my first anxiety, panic attack, I’d say my, my mother told me, years later that she basically knew it was going to come. Like she knew I was going to start having some kind of anxiety issues. This is like, we’re talking 1978, so I feel like I’m very lucky that my mother was enlightened to the point. I got to a psychiatrist, believe it or not, when I was about 13, which is really unusual, especially for that era. You know what I’m curious about Pegah is with you, like how was it with your parents? Like how did they react? And I find it really compelling that I don’t know your age, but I find it really interesting… we hear about people slipping through cracks in the medical system and it often happens… you can correct me if I’m wrong, but it often seems to happen when you have that first contact with a GP or with a doctor and with that professional. So, I’m wondering what year, what that journey was like with your parents or with your caregivers at the time?  

Pegah Mollahajian: Yeah, that’s a great question. So, I’m 25-years-old. I think my parents honestly didn’t know what to do. I think I come from a culture, I’m Iranian, mental health isn’t always an easy conversation in my culture, and I think that’s one of the reasons why perhaps I wasn’t given the right resources at the time. 

And it’s not that they didn’t see, they could see I was in. But they would just kind of tell me to ride out the wave and they became more complacent in letting me avoid certain things that were a trigger for me, and that’s how… They still tried to take me to the doctor, and I remember, I think I was about 14 years old when I went to the doctor with my mom. And we were kind of explaining the situation, and I remember telling the doctor, I run for fun, and I was part of the cross-country team in high school, and I remember my doctor telling me running can actually stimulate the fight or flight response. And she told me to stop running, and I will never forget that because now in hindsight I’m just like, I don’t get that advice and I could be missing something. Totally. But that was a short-term solution in my mind. And also, not really effective and also taking away something I really enjoyed. 

I don’t know if Dr. Taube-Schiff has anything to say about that, but that was kind of my… 

John Bateman: I would love to hear that too, because that seems counterintuitive to everything I’ve been told, right? Yeah.  

Pegah Mollahajian: Oh my gosh.  

Dr. Marlene Taube-Schiff: No, counterintuitive, I mean, there’s a whole body of research—I can’t say I know it all off the back of my hand—but there’s more and more research that has come out that has actually shown the beneficial impact of regular exercise, for sure, for depression in terms of mood enhancing effects that are very biologically driven. And I know that people have been looking into this in terms of for anxiety too. I’ve been at Sunnybrook Hospital and there’s been some research done looking on the impact of that for individuals with symptoms of OCD and the impact that exercise can have. And t here’s nothing I can’t imagine unless there’s like a medical condition, right? 

And I don’t know what that would look like, but that would prevent me from talking to people about exercise. When we think about the pandemic, too, what kept people. In terms of some, mental health impacts was exercise. Everyone I think got really bored of walking after a certain period of time. But it was something that people were doing to get out, to stay healthy. You could connect with people outside, like there were all these amazing benefits. I’m really taken aback to be honest, because you’re quite young, so I would still think that in this day and age, very surprising for a physician to say something like that. I always talk about the benefits of exercise. Then, this theme that was taken away from you too, because it can be a coping strategy. Running can be really helpful when we’re doing it and for a little bit after too. Yeah.  

John Bateman: Yeah. I’m glad you brought up depression because my anxiety led to depression. At least I think it did. It’s which came first at chicken or the egg? Doesn’t matter at this point, but that happened to me because when I was anxious, probably similar to Pegah, I got into serious avoidance behaviour. And that turned to isolation and that turned depression. What I’m wondering Pegah, is what, you know with your avoidance behaviour, what kind of effects did that have additional to your anxiety?  

Pegah Mollahajian: That’s a great question. So, a lot of my avoidance behaviour was going in public places and places that were really enclosed. I think I did have a bit of claustrophobia. I hated being in closed spaces. Like, movie theatres were not a go for me—anywhere where I thought I could not escape fast, like restaurants as well, things like that. And looking back, I’ve realized that I feel like I lost so much of my childhood experiences. That’s an age where we’re making friends, we’re really learning to have social connections. 

We’re learning lots of different things at school and on field trips that I didn’t necessarily always take part in. And so, I think a lot of the avoidance behaviour not only reinforced my anxiety but also it. It robbed me of some pretty big experiences in my childhood. It’s pretty sad when I think about it now because I’m an adventurous person by nature. And it’s hard to think [about] what could have been if I had the right resources and things like that.  

John Bateman: Yeah. And I certainly engage in that thought too because I’ve had, severe abouts of anxiety depression throughout my life, the most recent one last year. And I, for sure can relate with you on that FOMO, that the stuff that I missed out on. Just to let you know, what I started doing is I started thinking about how this condition can serve me in a positive way, and what positive things have come out of me having anxiety and depression. 

And one of the things I really felt was, in my experience, and you can tell me or maybe Marlene can let me know… When anxiety is present, there’s a lot in my case and a lot of people, there’s rumination, there’s thinking, wondering, what’s causing it? What is it? And it’s so easy to go down all the wrong paths that way. But I’m wondering… How it affects … through that rumination, through that turning inward, I use that as to my advantage in terms of Okay, yeah, I missed a lot of stuff, but I know more about myself than a lot of people do, and I feel like that’s a real plus as well. I’m wondering if you experienced that kind of thing, Marlene, in your practice or in dealing with that kind of, this huge chunk of your life gone missing. 

Dr. Marlene Taube-Schiff: Absolutely. I’ve seen that reported by so many individuals, and it’s so hard because sometimes when I was at Sunnybrook in the residential treatment program there for OCD, we would see individuals who had gone through many other kinds of treatments. That’s really how they kind of ended up in a residential treatment centre. And that’s something that, even as people would get better, they would talk about this idea of like time lost, and their peers being at certain like milestones that they’re not [at] and not being able to get back. That, those kind of opportunities in a sense, or just knowing that they’re a little bit off track.  

And it’s so important I think at that point to also be able to look forward to say, okay, totally, we need to grieve that. But now … we would sometimes see people, and I’ve seen it in my, a private practice that I do, almost this idea of like, how can I get better? Because then what was the last, like 30 years about if I let go of what it is, the anxiety or the rumination or the review, like how do I let go of that? What was the point of me doing that all these years? And it’s like, well, what do we want our lives to be right now, and how do we kind of move forward and be able to see getting better as a real opportunity to move towards things that matter to you and that are important to you. But especially because, like we were saying at the beginning, anxiety can hit when we’re in those like formative, developmental years that we want to be with friends and we want to experience things and get autonomy and agency from our parents, anxiety can really keep us stuck and not feel like we can actually kind of grow up in the way that we want to and do the things that we want to do. So, I think lives definitely get very interrupted, unfortunately, by anxiety.  

John Bateman: Yeah. And it’s interesting that you mentioned seeing our peers moving forward and what we consider to be a normal, healthy way. I found that what really helped me with that was being transparent with a few of my peers who were willing to help. I had friends that, and I don’t begrudge them who kind of didn’t understand and kind of moved off for a while, and then I had a couple of friends that really stuck with me. And I really feel it’s important to find that kind of support. Pegah, have you found that kind of support within your peers? 

Pegah Mollahajian: I have! I’ve been very fortunate. Once I started sharing my story with some of my friends, I was so surprised that they had so many similar experiences, and that was really important for me because I realized like, it’s so much more common than we think in society. And when I started talking about it and I started talking about the MindShift CBT Groups [program], I had so many friends who were actually interested. And it was really nice to feel supported and understood when, for a great part of my life, I didn’t even know how to talk about it. That was a huge for me.  

John Bateman: I would like to move to, you mentioned [Anxiety Canada’s MindShift CBT Groups] … I found one of the most helpful type… I’ve taken, you name it, [every] kind of therapy and I’ve tried—it just about everything. Acupuncture, you name it. It’s like there’s a laundry list. And I feel like that was all the process of finding out what actually works for me.  

Pegah Mollahajian: Yeah. 

John Bateman: So, you guys have both… one’s a counsellor; one’s been in counselling. I found incredible benefit from group [counselling] or group work. And I’d like to ask both of you, what are your thoughts on group and how come you feel like this is such an effective treatment for people dealing with anxiety? Maybe Marlene can go first, then we can hear Pegah’s.  

Dr. Marlene Taube-Schiff: Sure, absolutely. I’ve run so many groups as a professional, and I think they give you two things that are very important. There’s one kind of part of the group, which is like the delivery of, I do a lot of CBT work, so it’s the delivery of like content and skills, and that could be lovely of course to be able to receive from a professional. But the other piece is the connection with other people who have the same lived experience as you that a professional cannot impart in the same way.  

John Bateman: Yeah. Yeah. 

Dr. Marlene Taube-Schiff: Whether you’ve had it or have not, it’s really something that moves away from your professional delivery. So, you’re able to get that very openly and transparently with other members in the group. And there’s like this dynamic, especially in closed groups, which tend to be what I run now, where people kind of move through a group together for eight weeks, 12 weeks, know each other, and they get to hear each other’s stories. And they can also create, I think, a lot of perspective on what you are experiencing from an anxiety perspective. So, it can either be like, “Wow, they have the exact same symptoms as me, or the same worries as me.” And that’s like amazing to hear from someone else. Or you can also hear someone else’s anxiety and story and be like, “Oh, that’s interesting. That’s not something that I worry about. I don’t focus on that.” And how interesting that anxiety can come up in all these kinds of different formats, right? I think the power of the group, which is like a long kind of documented research phenomenon is extremely beneficial, and it’s nothing you can get from facilitators in a group. And sometimes people still hesitate, very understandably, to be in groups. And we really try to sell them with the idea that you’re going to get this amazing connection from people. And sometimes people meet in groups, and they continue to support each other long after groups have finished. 

So, I can’t say enough things about how good I think groups are. And lastly, just from a research perspective, they are just as effective as individual therapy. So, we have a lot of confidence when we carry out treatment in a group that we are delivering the same kind of effective treatment and therapy. 

John Bateman: Yeah.  

Dr. Marlene Taube-Schiff: But Pegah, I’ll let you take it away with all your…  

John Bateman: Before she starts, I just want to let you know, like, yeah. Before we flip it over to Pegah, because my group experience is really unique in the sense that I live on a really small island out here in British Columbia.  

Dr. Marlene Taube-Schiff: Oh, wow.  

John Bateman: And so, when I walked into my first group, it was different in the fact that I knew literally everybody in the room. And I’m not joking. I knew everybody in the room, and they all knew me.  

Dr. Marlene Taube-Schiff: That is different.  

John Bateman: And yeah, well, it is, but you want to know what? It really helped in a way, because what it showed me is it showed me that I saw all these people that I perceived as functioning in society really well, all of a sudden, like me. And having that veil come off really helped me. So, Pegah, describe to me what your first foray into group was like.  

Pegah Mollahajian:  Basically, my first experience was logging on onto a Zoom chat, then seeing the counsellor, and also, [there were] about 10 people in the group.  

John Bateman: Wow.  

Pegah Mollahajian: Eight to ten. And then I saw eight other faces on my screen, and the difference between seeing them the first time and seeing them during the last session, like it was it was pretty crazy because they felt like a family in sort of way. 

Marlene really hit the nail on the head because there was the benefit of having the actual content; obviously [that] was very helpful, but then forming relationships with other people who are going and having similar experiences to you or hearing how their story differs just broadens your horizons… It makes you realize and appreciate how diverse everybody’s experiences are with anxiety. And it’s so helpful to hear how other people deal with it because they might have strategies that you haven’t even thought of. And it just makes you feel so much more, I want to say, at home in a way. 

Because they get it. You don’t have to explain it. They understand. And that’s a feeling that I think I was chasing for like half my life. Basically.  

John Bateman: Yeah, that’s one of the fundamental messages for anybody experiencing anxiety is the fact that you’re not alone. Because it can be so isolating. And even when you’re sitting one-on-one with a counsel lor, with me, it’s not like I’m thinking actively, I’m not alone, but it’s not the same. It’s all of a sudden… In a room or virtually with eight other people experiencing the same thing …with different… symptoms going on. 

So that, yeah, I feel like that group has been very valuable in terms of that one piece that I think everybody needs to know: is that you’re not alone. I think I wish everybody could see the statistics and everybody could know when they’re standing on a crowded street corner or when they’re sitting in a classroom that there’s a pretty high percentage of people that have anxiety. 

And there’s a pretty high percentage of people that … have debilitating anxiety. But we need to know that. And I think that’s what’s great with group. Outside of that, like, you know what I’m wondering, and I’ll ask Marlene, what kind of coping mechanisms do you find… really helpful for people who are… dealing with anxiety or trying to maintain an anxiety condition? 

Dr. Marlene Taube-Schiff: Yeah, that’s a great question. I mean, as I was saying, I come very much from a CBT (cognitive behaviour therapy) background, which is very aligned with Anxiety Canada and the MindShift app.  

John Bateman: I love CBT, too.  

Pegah Mollahajian: Yeah, me too.  

Dr. Marlene Taube-Schiff: It’s really wonderful. When we think about seeing individuals with any kind of anxiety, behavioural strategies can often be a really good way to start. 

Because there’s often, as you’ve both been saying, a lot of avoidance, right? So, it’s really kind of jumping in, supporting people to be able to do what we call exposure therapy. I work a lot with individuals with OCD, so we do a lot of what’s called exposure and response prevention work. And there’s a piece of it of learning that your anxiety at times can come down with repeated exposure to something that has been triggering in the past. But it’s also putting on what we think of as like a bit of a values lens. And that comes from acceptance and commitment therapy, where it’s like, how do we want to start doing things that are of value to us. So, sometimes it’s not just doing something that makes me uncomfortable for the sake of being uncomfortable, but what do I want to get back in my life? What am I avoiding? Starting to see friends again, starting to go to work again. Those kind of big bucket things and how do we look at our values and all the things we’re avoiding that align with our values? 

I find that’s a really helpful way for people to be able to start engaging in therapy, because then … you’re getting something back; it’s motivating to do those things. In addition, I guess to behavioural strategies, I do a lot of cognitive therapy work, so we want to be able to look at some of those negative or anxious thoughts that we have. We want to be able to challenge them, balance them out. And then I think aside from that, not when we’re doing exposure work, but things like relaxation, mindfulness, all those things can be very important, right? They serve different purposes relaxation strategies versus just being present in the moment in a non-judgmental way. 

But those are all things that I like to integrate into the anxiety work that I do. I think all those different skill sets really serve a nice purpose for people when they are struggling. So, it’s kind of [seeing] where people are at and what they’re presenting with and kind of where I would want to get started. 

John Bateman: Yeah, I love that idea and I hadn’t really heard that. It’s a novel idea to me about looking at the things in your life that you want to start reclaiming. I never looked at that. Because then it gives you, definitive goals. Yes. In terms of those typical, I shouldn’t call them typical, but those strategies, you hear the good sleep hygiene, good diet, exercise, relaxation… mindfulness, all that kind of stuff. 

When I first would get into a real, desperate situation, I would throw everything at it. Like, you name it, I would have a call sheet. [To] the point that my whole day is basically dominated by dealing with my anxiety, and I’m not doing anything but. So, I’m wondering with Pegah… so you do group… oh, so basically, let me finish. So, what I did was, I basically just started doing two or three at a time and they would naturally shed if I wasn’t doing them. I tried meditating; I can’t. I tried journaling; I can’t. I can definitely catch thoughts; I definitely like exercise. There’s things like that. Pegah, with you, in addition to your group, what kind of those sort of more traditional techniques did you incorporate, or do you incorporate and kind of what works for you and what doesn’t work? 

Pegah Mollahajian: Yeah, for sure. So, one of the things that has stayed with me my whole life is being involved in sports and physical activity and being outside in nature. I found those things to be so therapeutic. And yeah, I didn’t listen to the doctor when she told me to stop running. I kept running that’s definitely one of the things that stayed with me basically throughout my whole journey. 

Just having an exercise routine, being involved in sports. And it was also a way to force myself to be kind of in a community and a social setting. So that was great. And then, some of the things that really worked for me that I learned through group was this exercise of balancing your thoughts, so catching thoughts that are very intrusive. 

I think we call them … hot thoughts, because they immediately evoke such a strong emotional response, and kind of catching those thoughts and then working through them in a really systematic way, identifying the… I can’t remember what they were called… but identifying the… thinking trap! There it is.  

John Bateman: Oh yeah. Thinking traps.  

Pegah Mollahajian: Yeah, exactly.  

John Bateman: Catastrophizing, fortune- telling… 

Pegah Mollahajian: generalization… All those. Yeah, those.  

John Bateman: I think there’s seven. Seven or eight depending on where you’re looking. 

Pegah Mollahajian: I actually had them printed out and on my wall for a long time.  

John Bateman: Oh yeah. You need them, they’re good for reference. Yeah, for sure. Yeah. 

Pegah Mollahajian: and then balancing the thought, so trying to make it a little bit more balanced and perhaps introducing other perspectives that you haven’t considered basically.  

John Bateman: Is this something  

you would write down? Like, would you do, would you… because there’s charts, right? 

CBT charts for thoughts. Do you actually use a chart?  

Pegah Mollahajian: Yeah, there was an app that we used in group, and it had this all ready for you, and you could choose the thinking traps and you could write your thought. So, I did that for a long time and honestly, if I find that something I’m having like a reoccurring thought, I still do it because it’s so helpful. 

I think my issue with like, those hot thoughts was that they happened so fast, and my reaction was so automatic, [that] I couldn’t actually consider it and see if it was really realistic. It just happened and it was so fast. This really helped me actually consider what the thought was saying to me, and how I was reacting to it, and how I could perhaps introduce another perspective that would make it way less intrusive to my life. 

John Bateman: Yeah, I negative… those thinking traps are quite, for me, from my perspective in terms of CBT, are quite core to the process. I had a hard time doing the writing down, and you’re gathering by now that I’m lazy when it comes to journaling, writing things down—I don’t know if it’s lazy or whatever. 

So, I started by just catching a negative thought, not even identifying it, not trying to pick it apart, just catch it one at a time as it happened. I’d have one—if one happened, five seconds later, I’d go, There’s a negative thought. If one happened two hours later, I’d say, there’s a negative thought. And then I progressed into the thinking traps from there. 

But Dr. Taube-Schiff… What kind of ways do you suggest in terms of… because negative thinking and thinking traps are so core…what ways do you suggest people deal with these thoughts? Because our brain’s a crazy thing. Our brain is a crazy machine. 

What are your strategies in terms of incorporating the thinking traps or working with them? 

Dr. Marlene Taube-Schiff: Very similar to what you are both describing in terms of that idea of like increased level of awareness, being able to notice the thoughts, catch the thoughts, move towards kind of labelling what they might be in terms of those thinking traps. And then, that idea of looking at them for different perspectives to be able to balance them out, right? Because we’re not trying to replace bad thoughts or negative thoughts with good thoughts. We’re really trying to honor what it is about that thought that feels quite real and what we might have evidence for. 

But we also want to look at the other perspective. What do we have evidence for that goes against the evidence, against that thought, right? And that really gives you the kind of alternate, alternative or balanced thought. And I think something else is that idea of like, we want to not be afraid of our thoughts, right? 

We want to really learn that like thoughts are just thoughts and really accept that, because we all have, I don’t know … thousands of thoughts a day.  

John Bateman: feels like millions. Yes. 

Dr. Marlene Taube-Schiff: Millions of thoughts a day. Exactly. And most of them kind of come in and out, even as we’re all talking to each other. 

Right now, we’re thinking, well, what am I going to do after? What am I going to do tonight? Our mind keeps going everywhere. But those thoughts aren’t—they’re not bothersome. They’re just thoughts that aren’t those hot thoughts, that are like emotionally laden. So, it’s really also knowing that a thought is a thought whether it feels like it means that something catastrophic is going to happen, or whether it’s just about me making a decision about what I’m going to have for dinner. There’s still actually the same thing. So how do we kind of lean into some of those thoughts that can cause us more distress and see them, if you will, for what they are. 

So, that’s a conversation that I tend to have with people a lot in the beginning from a more psychoeducation perspective and also as we continue, because I think it’s a lot sometimes for all of us to wrap our head around, because if there’s a thought in our brains that feels like very important, it’s hard to say, I’m not going to kind of hook into that, right? . So how do we unhook from thoughts and shift away to things that feel like they’re actually more deserving of our attention? So that’s sort of a conversation too.  

John Bateman: Yeah. Catching those thoughts. I know, and that’s, to me the hard thing about those, when I was learning about them… well, I’ve heard them referred to as ants: automatic negative thoughts. 

Dr. Marlene Taube-Schiff: That’s a good one.  

John Bateman: To me, it’s kind of like, you talk about that scroll in your head of thoughts. I just find it, I think it’s really important that you, it’s, it can be like, good thought, good thought. Neutral thought, good thought, neutral thought, news about bad thought cause and it’s hard to even recognize those negative thoughts when they’re creeping in. 

but it’s so important, I think, in breaking that cycle and putting them into context. 

Yeah. I could literally talk all day with you guys. This has been, I would say, this has been a really successful venture. Having both of you to talk to I really value what you’re doing, and Pegah, with you, being an advocate, it’s incredibly helpful. You talk about your parents not really knowing what to do. If and when you decide to have children, you’re breaking the cycle. 

Pegah Mollahajian: Exactly.  

John Bateman: Now, I’ve done this thing with my kids who are 17 and 20 now. And Dr. Taube-Schiff, I really appreciate the expertise you’ve brought to this. It’s been… 

Dr. Marlene Taube-Schiff: Oh, thank you.  

John Bateman: Oh, it’s been so helpful. I’d like to thank you for joining me and I hope we can do this again. I would love to talk to you guys again in the future, and I’m sure we’ll figure something out. And, because it sounds like we could talk for hours and hours.  

Dr. Marlene Taube-Schiff: Sounds great. 

John Bateman: Thank you for joining me.  

Pegah Mollahajian: Yeah, that was a great experience. Thank you so much.  

John Bateman: Okay, awesome. Take care.  

Dr. Marlene Taube-Schiff: So, take care.  

John Bateman: Okay.  

Pegah Mollahajian: Take care. 

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