Leaving my house gives me the tingles. Agoraphobia is defined by an extreme or irrational fear of entering open or crowded places, leaving one's home, or being in places from which it's difficult to escape. 

By the end of this video you'll know what agoraphobia is and what I tell my patients on how to treat it. 

It's theorized that agoraphobia starts when an individual has one or more panic attacks, causing them to worry about having another attacks and avoiding the places that it happened. The thing about panic however is that it can happen anywhere and the brain is soooooooo good at remembering the places. It sends out the signal that those places are dangerous. People start realizing that their world starts shrinking and shrinking and shrinking. I can't go to grocery stores any more, gas stations are out of the question, driving is a no-no, the last social event caused me to panic, those are out. Forget flying or any type transportation because I cannot get out if I start to panic. 

You know the safe place to be. Home. I don't panic at home. What ends up happening is that this magical illusion that home is safe becomes a reality. If the person attempts to leave, even to get the mail, they panic because....they've told themselves that home is safe and WHY ARE YOU NOT IN YOUR HOUSE! How about I give you a panic attack to set you strait. 

You can see how difficult this can be for someone. Why panic if we don't have to. Even at the expense of others and missing out on life. 

It's not only panic that sets in, but various physical symptoms. Chest pains, chills, diarrhea, feelings of choking, feelings of unreality, nausea, numbness, rapid heartbeat, shortness of breath, sweating, and shaking. Yikes, with all of these physical symptoms after leaving the house, why would you. 

Typically agoraphobia doesn't just start overnight. It's a longer process of eliminating the places, people, things around you. 

So how do we get out of this sticky mess! The most effective treatment that works for agoraphobia is called exposure and response prevention.

Essentially, you are facing your fears, sensations, panic, and anxiety. Most start slow. They write down all the places they would like to revisit and go and rank them from easiest to go to, to hardest. The ideas is to start getting yourself to that place, but in the right way.

Here is what I mean. If my goal is to get to the mailbox. I may be focusing on sitting on my front porch and noticing how much distress or panic this brings. I need to sit on my front porch, feeling all the feelings, and respond differently to them. If panic attacks happen. Great! We don't run. We don't fix. We sit with the feelings. Some may even say, "yep" there is the panic attack. Sweet, it may last forever. Focusing on taking all this value away from it. Panic isn't the enemy. Your body thinks it's keeping you safe. The panic and distress have to go down. When the distress levels go down, you haven't done any compulsions and you've responded completely differently, some may walk inside for a few minutes and then do it again. 

Repeat until the distress levels just simply don't rise as much as they used to. Then, the person chooses to move closer to their goal. Maybe it's sitting in their yard. Read a book. Be there. Again, not fixing, not running, embracing the feelings. You then move closer and closer. Each time this process is done, the brain learns who's the boss. You are the boss. We repeat this for everything on the list. 

Ultimately, it's accepting that there will be panic. But it can't hurt you. You can teach it that you're cool with it. Physical symptoms can happen, but you're staying put. It can feel like a tough process, but I find that the anticipation of doing these exposures tends to be worse than the actual thing. 

You need to learn to respond the correct way with these panic attacks, click right here to watch my other video on how to do this. 

Have you struggled with agoraphobia before? What places do you avoid?

Thanks for watching and I will see you next time. ​

Man, have you ever noticed that anxiety tends to increase as it gets closer to nighttime? In this video, I am going to give you 10 tips to help you calm this pesky nighttime anxiety and help you get a better night sleep.
There are many statistics that show that many individuals struggle with sleep on a regular basis. In fact, 50% of those who are sleep deprived say that their anxiety impacted their ability to sleep. it's like a double-edged sword. Anxiety tends to cause less sleep and having less sleep tends to cause more anxiety.
Our brain is simply tired at the end of the night. We've had 1000+ different thoughts, we had problems to solve, homework to do, and really, the biggest thing we're thinking about is....those things we don't know. Our brain can get so stuck on the future, the what-ifs, the things we have no control over. This is where anxiety loves to live.
To teach this anxiety who's the boss, here are your 10 tips to help with your nighttime anxiety.
#1 - Practice meditation - We need to learn to calm our brain from the day. Teaching it to not problem solve before we sleep. Some day, while we dream, our brain is throwing out useless information and even problem-solving. Some suggest this starts too soon, before we've gone to sleep, causing extra thinking and more anxiety. Meditation can be anything from starting a guided meditation you find online, to using your 5 senses to notice the things around you and practice not using judgment with them.
#2 - subscribing to this channel. It'll power you up. But really!
#2 - Practice good sleep hygiene - This typically means having a good schedule. You watch tv until a certain time, you turn your phone off at a certain time, you get to bed at a certain time. Consistency is the key. This may even mean limiting naps in the day and limiting caffeine or alcohol. Sticking to a schedule that you can count on trains your brain to sleep when it needs to sleep.
#3 - Avoid stressful activities before bed - It's important to create a transition from daytime to nighttime. The goal is to teach the brain that daytime Is for problem-solving and thinking, and nighttime is for relaxing. This may mean, no work past a certain time, no news and no social media. Some may even find that watching TV right before bed presents an issue.
#4 - Limit screen time - Have you heard of "blue light" - it tricks your brain into thinking the sun is up. It keeps you awake. Professionals suggest shutting down all screens 1-2 hours before bedtime to minimize sleep interruptions. This also allows your brain to slow down and prepare for sleep. For some people this is a must, for others, that's just part of the lifestyle. There are blue light filters to minimize the blue light. This isn't only for your sleep, but for your anxiety.
#5 - Use a weighted blanket - It's like a hug, but without the hug. Weighted blankets produce calming effects. The deep pressure can help increase serotonin and melatonin while decreasing cortisol. Ultimately, this promotes feelings of calmness and peace.
#6 - Exercise in the day. Exercise reduces the production of stress hormones. With less stress hormones, we tend to have less anxiety. Regular exercise has shown to help people fall asleep faster and more soundly. Even brisk walks. However, Individuals should avoid vigorous activity at least 1 hour before bedtime.
#7 - Set aside time for winding down - This is all about routines. Think about things that get you in the mood to sleep. Dimming the lights, listening to calming music, a warm bath. At least 30 minutes before bedtime, individuals can start this transition. Schedule this out. I am sleeping every night at 10:30 - The body and brain need to know this routine.
#8 - Write worries down on paper - Sometimes our thoughts just won't stop. But that's okay. Thoughts are thoughts. Some find it helpful to pull out a piece of paper and write down thoughts in the day. Anxious feelings or things they need to get done. The act of putting them on paper often tells the brain, it's here. I'll get to it when I get to it. But what you'll find as well is that most of things you're writing are things you have zero control over. Or they are things in the future that we are unsure of. Teach the brain that you wrote them down and are no longer problem solving them. Sometimes a quite answer to the brain like, "okay" "cool" "gotcha" can signal that you have the thought, but aren't moving any closer to it.
#9 - Avoid lying in bed awake - Leaving the bed may feel counterintuitive, but getting out and doing something relaxing can help calm the body and almost reset the loop of thoughts. This doesn't mean pull out your phone and scroll through social media. Ultimately, this conditioning is known as stimulus control and can reduce the time it takes to fall asleep. If you try this, it's important to actually leave your bedroom, get a mental reset, and try again.
#10 - Let thoughts be thoughts - The more you try to control them, the more they have control over you. Practice not putting any value to these thoughts. It doesn't matter if they bring anxiety or if they are random. Let a thought be a thought. Just like before, answer like, "okay" "cool" "gotcha" or "maybe, maybe not" signal to the brain that it's just not your thing to figure out all the thoughts. That may have it's place another time.
Ultimately, what's important to know is that many have anxiety about the act of actually falling asleep. It's actually okay to feel anxious. The body is throwing out false signals. Allow your body to do what it's going to do. When anxiety arrives, you can acknowledge it. Hey there, welcome. You can stay or leave whenever you want. The more we take value away, the more the brain learns from these experiences and is less likely to bring it again next time.
So what'd you think? What helps you with your nighttime anxiety? Let me know in the comments.

Ride the wave of anxiety using DBT skills​

Imagine yourself facing a monster. Maybe it’s your anxiety or OCD. It can take on any form. It can look like anything. It can be tall, small, short, big. It can have claws, horns, sharp teeth. It can be furry, bald, or however you’d describe your monster. Between you and the monster is a giant pit that represents your symptoms. The never-ending feelings of anxiety or OCD. The nagging questioning and doubting that anxiety loves to bring. This canyon or pit is BIG. Real big. You can hardly even see the bottom. It almost feels hopeless that this big pit will be there to stay forever. Now imagine yourself near the edge of this pit holding a rope. The rope spans across the pit. Guess who’s holding on to the other end. You guessed it, your monster. That pesty thing.

You are stuck in a perpetual tug of war. To not fall into the pit, you’re holding tighter. I mean, the rope has been your security and safety this long. (the rope are your compulsions….the things that your anxiety says will keep you safe) They are the….”just check the stove one more time” “are you sure you’re a good person, go ask mom again.” “better research again to make sure you didn’t really do that thing.” As you’re pulling this rope, you’re in constant battle with your symptoms. The monster. It really doesn’t budge, it won’t go over this pit.

​You think that the more you pull this rope (do the compulsions) the closer you’ll get to finding freedom and allowing that monster drop right into the pit. The sad part is….the monster gets right to that edge and does one bit TUG, pulling you right back into those compulsions and making you doubt all over again. It can feel never ending. The only thing the brain says is to keep trying….you almost had it. This cycle repeats over and over again. There is one thing the monster doesn’t expect……..you drop the rope. That’s right. You have all the power in the world. You’ve been feeding it this whole time. You stop doing the compulsions. You stop trying to figure it out. You stop all of it. You allow the anxiety to just be there. You even act like you don’t care. The monster is ANGRY man.

It screams across the pit telling you to pick the rope back up…it’s the only way…it throws out these threats… You answer each threat by agreeing with it or saying, “yep, maybe.” “cool, thanks for that thought.” You learn that the chatter of the monster slows down. It finally takes a seat….It’s no fun for this monster. You’ll realize that the threats it’s ever given you have been false this whole time. The urge to pick this rope back up becomes less and less. It takes commitment, but you do it. You’re dedicated to NEVER figure out your “what if” or to react to any “perceived threat” that comes your way. You’ve gained control again.

You’re the boss. You may feel like you didn’t “win” the battle, but you’ve accepted it for what it is. Acceptance is key. You’ve learned to live with this monster regardless of the threats. Some days it’s tougher, some days it’s no big deal. Regardless… you live the life you want to live. Ultimately, what I want you to do is to figure out what you’re still holding on to and allow yourself to “drop the rope”. Your time is NOW. Make sure you check out my online self-directed OCD course to help you drop the rope and learn the correct treatment for your own OCD. What things do you need to drop the rope with? Thank you so much for watching and I will see you next time. ​

Stop moving the cup. Let me tell you what I mean by this.

 So when I say stop moving the cup, this is what I mean. A few years back I was at my brothers house. We are all seated around the dinner table talking and laughing.  Their dinner table is located right next to their white carpet. My three-year-old periodically would run up to the table grabbed her cup of juice,  grape juice of all things, take a drink and put it back on the table.

 What I noticed is that when she placed her cup back on the table it would be close to the edge.  I would continuously move the cup back to the middle of the table. Just as I was done, she would run back, grab the cup and follow the same routine. Slamming that cup back on the edge of the table.  I found myself  moving this cup over and over and over again.  I didn’t wanted to fall, I didn’t want to hit their white carpet. I felt like I could prevent this.

 Little did I know, the more time I spent moving this cup, the more ingrained I got into the perceived threat that this cup was going to fall. So ingrained that I missed out on the conversations happening right in front of me.   By the end of the night, I probably move that cup 20 times if not more.  Guess what ended up happening, nothing. Nothing happened.  Her cup did not fall.  The catastrophe I was trying to avoid did not happen.  And my brain said,  good job…. You did really well preventing this threat from happening. My brain didn’t know any different,  it really thinks I did a good job.  But what if me moving the cup had nothing to do with the catastrophe not happening. 

It seemed like such a silly thing, but it got me thinking.  How many times in our life do we have a perceived threat, something more completely guessing that could happen we are doing behaviors to prevent it. Even if the catastrophe actually did happen, we would be able to problem solve it.   Think about this for yourself, how many times a day, a week, an hour are you trying to prevent something bad from happening. How much of life do you feel like you’re missing? 


 Life is meant to be lived. We are meant to make mistakes.  We are meant to fail.  We are meant to let the chips fall where they may.  We do not need to solve the problem if there is not an actual problem.  The cup on the edge of the table is not a problem. It could potentially be a problem,  but at this moment it is not a problem. When we focus more on living life and enjoying the things around us,  it is worth more to risk the perceived threat happening then to continually problem solve it and prevent it from happening.

 When it comes to anxiety and OCD symptoms, the perceived threat happens day after day after day after day. The brain thinks that the only reason it hasn’t happened is because you may have done a compulsion or followed its rules. When we are doing treatment we have to retrain the brain to say that it is completely lying to you. When we don’t do the compulsion,  and in my case it would be moving the cup.  We allow ourselves to see what ends up happening.  When we find that the catastrophe doesn’t happen the brain learns that the threat it gave you must’ve been false.  Thus reducing the amount of threats you make it in the future. 

 But if the catastrophe actually does happen, we can problem solve it.

 So when I say stop moving the cup, what I really mean is stop doing the compulsion.   Stop trying to prevent the bad thing from happening unless you see immediate danger. Meaning there is no doubt in your mind that you are in danger, you don’t even have to question it. If you do have to question you already know it’s a perceived threat. 

 And I know what you’re thinking.  Yeah Nate, your examples about grape juice falling on white carpet.  Mine is so much more serious than that.  Do not fall into the trap that your  perceived threat is more important or is different than someone else’s. It doesn’t matter what intrusive thought comes your way, we treat it the same. 


 Stop moving the cup. Risk the threat.  Is worth living life, than to live life to problem solve. 

 My question for you is what is going to be the thing that you are going to stop doing today?  What cup will you stop moving?

 Thank you so much and I will see you next time…

Imagine getting this voicemail at the time the school bus is supposed to arrive. Anxiety provoking right? I mean I sent my 5-year-old to kindergarten. They sent emails and made comment assuring us that “our child will not get lost”. I didn’t even ask for that assurance, they just offered it freely. 

As a therapist who strives to live my life with uncertainty, I initially wasn’t worried. Like I always say, when there is a problem, we’ll solve it. 

What do you think? Is there any question in your mind that THIS IS A PROBLEM?

This is what I’ve been talking about all along. When your anxiety hits you and you’re anticipating a problem, you’re guessing a problem, you’re living your life as if there is going to be a problem……IT’S NOT A PROBLEM. 

A problem needs to slap you in the face.

You need to not have any doubt that there is a problem to be solved. If you cannot physically see or hear the problem that slapped you in the face. 
(b-roll slap face)

Then you’re feeling false anxiety and are reacting to something that isn’t really there. The body needs to learn that you ONLY react to REAL problems. 

So back to the story. The bus was supposed to arrive at 3:30….. it didn’t show.  The call was given at 3:30 – what was I to do? Problem solving kicks in, the anxiety kicks in. 

This is what it’s designed for. What would you do in this moment? When there is a real problem presented in front of us, we have to focus on what we have control over. 

I can call the school for an update.
I can get in my car and drive to the school.


There really isn’t much more I can do. Here’s the kicker. The brain automatically plays out situations in our head. These are the what if’s. and guess what? We can treat them the same as ANY OTHER PERCIEVED THREAT. Yes, I do have a real problem presented in front of me, but I practice not reacting to the guesses. 

We do this by using a lot of maybe, maybe not statements, even though it can be very scary. My brain went to the worst….
Did she get kidnapped?
Did she get on the wrong bus?
Did she think she could walk home?
Is she wondering around the school?
Did she get hit by a car?
Did she pass out somewhere?

These guesses are NOT THE PROBLEM. My perception is. I can answer each of these with a “maybe” or “possibly” --- because all I know is that they cannot find my daughter. 

Man, this is incredibly tough to do, but it’s ALL WE CAN DO. So in short, we focus on what we have control over and leave the rest uncertain. 

If I reacted to “did she get kidnapped?” what am I supposed to do? Call the police and report a possibility, just because it came to my head. Drive the neighborhoods looking?

Here is what ended up happening…….10 minutes later I got this voicemail. 

(b-roll answering the phone)

I now know a solution…get in the car and pick her up.  That’s what we did. When we got to the school, the teacher was sobbing, the school was apologetic, my daughter was well….. only sad because she didn’t get the chance to ride the bus with her brother on the first day. 

I mean, you were told to get on the wrong bus, following blindly the directions of others, taken back to the school and picked up by your parents. 

Man, kids are resilient. Here’s the deal….What we learn is that giving assurance or reassurance doesn’t work. The school sending an email assuring all the parents that everything is going to be fine is a guess. This is most assurance giving. A complete guess. We need to learn in our life to either 
1. Not give assurance unless we know 100% (something like, gravity will continue to hold us to the ground)
Or 
2. Leave things uncertain, teaching us and our kids to allow life to be and solve problems when there are problems.   

We can only prevent so much and must allow life to just be. So why am I telling you this story? 

I’m sharing this story as an example of when we need our anxiety. These moments happen rarely. I mean it. RARELY. And even with real danger anxiety, we still can practice uncertainty. 

Treatment for anxiety is uncertainty. Allowing yourself to risk the what ifs. Allowing yourself to live life regardless of the buzz reminding you of dangers. Because you don’t follow those “what if’s” anymore. 

So tell me, for the times you feel anxiety, how many of them are REAL? Meaning, How many have actually manifested the way you thought they were going to. You see, we forget about the times it didn’t happen are really good at remembering the times where the catastrophe or “bad” thing did. 

Your job when you’re feeling anxiety is to quickly look around you for immediate danger. If you don’t see any, you treat it as a false alarm by using the magic words….”maybe, maybe not.”

Stop living in the future of what ifs. Instead live and enjoy your life NOW. 

Nothing is like the real deal! We all know that. But, research has shown that we can use exposure and response prevention for the fear of needles. Here are some exposures that individuals may do. The point isn't to remove the anxiety, it's to teach your brain something new about the fear. That you're the boss and you can do hard things. ​