Regulate & Rewire: An Anxiety & Depression Podcast

Health Anxiety: How to overcome it (Part 2)

September 12, 2023 Amanda Armstrong Episode 30
Regulate & Rewire: An Anxiety & Depression Podcast
Health Anxiety: How to overcome it (Part 2)
Show Notes Transcript

EPISODE 30

If you’ve been trying to heal your health anxiety & haven’t been able to, it might be because you’re missing one of the 4 evidence-based approaches I discuss in today's episode. My hope is that this 2 part mini series on health anxiety gives you a really clear roadmap as to some possible next steps on your journey to overcoming health anxiety. We'll discuss the brains built in negativity bias and why some people can calmly float through health issues and other cannot before discussing the 4 different approaches. Hit play to learn more!

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0:00  
Welcome to regulate, and rewire and anxiety and depression podcast where we discuss the things I wish someone would have taught me earlier in my healing journey. I'm your host, Amanda Armstrong. And I'll be sharing my steps, my missteps, client experiences and tangible research based tools to help you regulate your nervous system, rewire your mind and reclaim your life. Thanks for being here. Now let's dive in. 

0:28  
Welcome to part two of our two part mini series on health anxiety. As with all of the mini series that I do here on this podcast, I always recommend starting from the beginning to give you some context for what we're going to talk about today. So if you haven't listened to last week's episode, here's my little plug to go start there. And for those who have, but still need a quick refresher, last week, we talked about what health anxiety is, we explored some common reasons why you might be struggling with health anxiety, my hope was that you had kind of like an aha moment there. Oh, yeah. Okay, this makes sense. And I offered an exercise at the end to help you become more familiar with your unique health anxiety cycle. And as a whole, my hope with this two part mini series is to help you understand what health anxiety is and how to overcome it. We are going to focus today on this four pronged approach of evidence based best practices to help you approach your health anxiety. So if you've been trying to heal your health, anxiety and haven't been able to it might be because you're missing one of these four approaches. And my hope is to give you a clear roadmap with some really practical next steps to help you tackle this. 

1:45  
So as noted in part one, if you don't struggle with health anxiety, specifically, but instead have a different flavor of situational anxiety, there is still a lot for you to gain from this episode. But when I use examples of health anxiety, I invite you to mentally filter this conversation through the lens, again of your unique situational anxiety, be it driving anxiety, social anxiety, or other. Now to start our conversation today, I want to help bring awareness to part of how our brain is wired. And this is something that I first heard in a workshop given by Rebecca from journey to wellness, and it was so good, I just had to share it again here. And it is this concept that worry is evolutionary, you've heard me talk before about our brain's negativity bias. And health anxiety loves to latch on to this built in negativity bias, especially if there has been any major direct or indirect health related experiences in your your past. And for most of us, I can think of at least one that we all globally, recently experienced. 

2:55  
So health anxiety loves to latch on to this natural built in negativity bias. And to help make this more tangible, let's do a quick demonstration. Again, if you are in a place where it is safe for you to do so if you're listening to this while driving, just proceed with caution. And when I say close your eyes, please do not. So for a moment, if it's safe to do so I want you to look around the room, you're in the environment that you're in and take a note of everything you can see that is green. So keep looking around and make a list of these green objects in your mind. What can you see that is green. Okay. Now, if it's safe to do so, close your eyes. And now make a list of everything you saw that was blue. Some of you are rolling your eyes, and maybe you're laughing. Those of you who are those A plus aspiring students may feel a little bit frustrated because you're like I was ready to make a list of all those green things. So this is an example of a negativity bias you were looking for all of the green things. So of course, you didn't take note of the blue things that you saw, or really any other color. You were filtering out all of the other colors except for green. And that is what a negativity bias and health anxiety often does. They start to filter out information that signals safety, good pleasurable, and focuses in on all of the somatic symptoms and triggers that it wants you to focus on that could be dangerous. And there's a part of our brain that is literally dedicated to finding patterns in our lives. That kind of again, is supported by and feeds into this negativity bias. 

4:54  
So another example of this how this part of our brain works is re cently our, our family decided that we needed a new car to kids and we, up until about a month ago, we're still driving my husband's car from college. Old Trusty Rusty greeny with a Cricut bumper, peeling paint. And last spring, I even found a grape vine growing out of the carpet. Now, some of you might be thinking, Oh, my gosh, how did you let it get that far. And friends, I just want to remind you, we all value different things. And driving a nice car just is not something my family cares about. But even still, even still, it just it was time. So we parted ways. We rehome to that car. But in the process, we decided that we were going to buy a Toyota Highlander. And as we were driving around, all of a sudden, I started noticing them everywhere. And the thing is, they've always been there. Toyota Highlanders have always been everywhere, they're a popular car, I just didn't start noticing them until I had a reason to my brain is filtering for patterns that are now relevant for me. Your system filters for information that it thinks is relevant to you based oftentimes on your past lived experience. If there has been a health related scare, well, health related information is really highly relevant to your brain into your system. 

6:27  
So again, because of health anxiety, your brain is trained to filter information that could be health related to so to you, it might feel like every single article that you read news story that you hear a conversation that you step into is about sickness, or that you're constantly aware of these symptoms in your body. For somebody else, who may have these same sensations popping up in their body who might be reading the same magazine or watching the same news channel as you, they may not even notice those various sensations or stories, let alone be triggered by them, because they have different filters than you. And the the lining of hope here is that we can train our brain to stop filtering so much for that specific information. Now, the exercise I invited you in to at the end of last week's episode is to help you start to see the things that your brain filters for. Because the reality is, those things are not an accurate representation of what's going on. Just like when I asked you to notice all of the green objects, and I put that filter on your environment. What you noticed was not an accurate representation of everything in your environment, just the green things, just the scary health things. 

7:48  
So now that we have kind of practiced with and understand this negativity bias, I want to again, start by sharing my most standard definition of anxiety, which is that it is an overestimation of threat paired with an underestimation of your ability to manage that threat. So health anxiety is that constant overestimation of health conditions or concerns, we've got a strong filter, they're paired with an underestimation of your ability to manage the health concern. Again, another filter there, instead of focusing on all of the days of your life, that you have managed to survive all of the sensations that have happened in your body all of the times, you were sick and made it through. We underestimate our ability to manage health concerns. So that feeling of tightness in your chest becomes a heart attack, that chronic back pain that might just be stored trauma becomes something that you have gotten four MRIs for, and no matter how many times your doctor says there's nothing physiologically or structurally wrong there. Your brain is still sourcing for a different explanation. 

8:56  
And I was recently asked by a client, how is it that I can turn a stubbed toe into a heart attack and point seven seconds. And yet there are people out there navigating a real health crisis, who get news that they actually do have cancer, and they can calmly and confidently navigate that. Or I even have a friend who has these like very random unknown symptoms. But it doesn't control her life, like these symptoms do mine. So it comes back to their equation and their toolbox. Either. They aren't overestimating the threat. They're simply taking things as it comes. And they have the ability to do that potentially because their lived experience is different. Their nervous system is more regulated, or a number of other factors could come into play with that. Or because they believe in their ability to face whatever it is because of regulation tools that they have filters that they've put to focus on their resiliency or support systems. Are people in their life. And some of you, at no fault of your own, do not have the same tools or systems lived experiences, or people helping to create the safety net around you. And we're going to talk a little bit more about that later on. 

10:19  
So today, I'm going to expand on this four part approach to overcoming health anxiety that will address both sides of that equation and more. And the four approaches to taking on health anxiety are number one, thought work, or CBT. So if you've ever been to therapy before, this is most often what you've experienced in traditional talk therapy, this cognitive behavior therapy, it works well for some people. But for many, many people, it often falls short. And in my opinion, it really falls short on its own, because it's missing these other three components. So the second approach is cultivating interoception. What does that mean? What does it look like? We talked about faulty interoception last week, number three is taking a somatic nervous system regulation approach. This, in my opinion, again, is vital. This is what creates safety and trust in the body. This is what rewires our reflexive nervous system patterns out of assuming danger and threat, and into being able to source for a sense of safety. And again, this is often what's missing from people's therapeutic traditional talk therapy experience or healing journey. And why the work we do with clients is so profound and transformational and healing is because we focus on the body first and sourcing for this felt sense of safety. And the fourth approach is CO regulation. And the reality is, I easily could have made this a five part miniseries giving each of these approaches their own episode. But for brevity and attention span sake, I am going to include them all here in a more condensed way. And if there are any of you who would like me to expand in future episodes on any of these topics, or actually any part of your healing, please write in and submit something to the Ask Me Anything form that is always linked at the bottom of the show notes. 

12:28  
So taking on number one thought work or cognitive behavior therapy. So this is this approach is about the interplay between our thoughts, our feelings and our behaviors. Like I said, this is what is most often what you experience in traditional talk therapy. And the idea is that we can't directly change our emotions. So in order to help us feel different, like reducing anxiety, we can pull the levers of changing our thoughts or our behaviors. And so some tools that are often employed in this cognitive behavior therapy, thought work approach are things like identifying our common thinking errors, learning how to diffuse from our thoughts, how to catch challenge and change them in real time. Recognizing limiting beliefs, maybe where they came from gaining some perspective or leverage over again, shifting those thoughts or beliefs. We can talk about changing behaviors. So especially with health anxiety, there are a lot of avoidance behaviors and reassurance seeking behaviors. And those can provide some short term relief. But the long term relief is going to be this somatic approach. 

13:39  
And not to mention when you're constantly either avoiding routine checkups, or constantly reassurance seeking with multiple scans and tests, when it comes to health related things, at least here in the United States. That's a really, really expensive endeavor. So like I said, there is merit to this in its own right. And in fact, inside our membership and our one on one coaching. Inside rise as we there are entire modules dedicated to this top down approach. But they always come after a strong nervous system and somatic approach has been taken because again, in my opinion, it is missing that key somatic piece that needs to come first for effective healing. Because you can do all of the thought work and the behavior changes that you want, but your nervous system doesn't care if it is still stuck in the state of alarm if you have stored and unprocessed stress and trauma. The survival energy that gets stored in our body doesn't speak a cognitive language. It doesn't speak thoughts you will never be able to think your way into safety. You have to feel it. 

14:54  
So in my opinion, this work happens most effectively. This thought Work cognitive behavior therapy approach happens most effectively in tandem with or after you have cultivated, more accurate interoception. You have tangible nervous system regulation tools, you've been able to create an access some sort of felt sense of safety in your body, or you know how to source for that when you've become dysregulated. And if this is the approach that you have access to give it an honest go, because it is true that having constant catastrophic thoughts in our brain having these beliefs around health, etc, can send stress signals to our body that exasperate that alarm that is there. And if there are other things contributing to the anxiety and state of alarm in our body, then thought work alone will not be enough to manage your anxiety. But gaining some leverage over or awareness around those thoughts may be helpful in minimizing their impact on exasperating this body based alarm. But if you have been trying to manage your health anxiety through talk therapy, and it isn't really working for you, it's likely because, again, your internal alarm is still turned on. And that needs to be worked with. 

16:14  
which leads us to the second approach with which is interoception. And I mentioned last week, that body awareness is this first filter of safety. So having awareness of your normal body sensations of how your physiology works at education pace, we'll talk about when we talk about our third approach, especially the ones related to stress or anxiety, the ones that so often spiral out into your unique health anxiety triggers. Having that education and awareness provides context for when those sensations show up. That context helps you to see them for what they likely are and navigate them accordingly. Without diving down the rabbit hole of what ifs. So what this looks like, for so many of our clients is before any felt sensation in their body, especially anxiety related symptoms, right, their heart rate speeds up, their chest gets tight, their hands get sweaty, their brain, immediately I'm dying, I'm having a heart attack, I need to go to the ER right now. And without changing anything other than helping them to understand that that is a normal and natural physiological response when your sympathetic nervous system is activated, gave them the context, so that the next time they are experiencing those symptoms, they had a different narrative where their brain still was like, Oh, my gosh, I think we're having a heart attack. But this other voice was able to come in and be like, Oh, but maybe not. Remember, we learned that these things can happen just because I'm triggered, I'm anxious, I'm really stressed out. And they were able to prevent themselves from completely diving off the deep end. And they were able to create enough pause, and eventually had enough tangible regulation tools to be able to create regulation so that they could then say, Okay, were those natural sympathetic symptoms, or sensations? Or is there actually something else going on here that might be worth going to the doctor about. 

18:23  
So it just that education in that context provides a filter. But that all comes through interception. Interception is your ability to sense internal signals from your body. And like we've talked about with anxiety or health anxiety, people often have what we call faulty interoception. Meaning that an individual has difficulty perceiving and accurately interpreting these internal sensations and signals from the body. So interoception is the sense that allows you to detect and understand signals like hunger, thirst, pain, your heartbeat, temperature changes, etc. And it plays a crucial role in your ability to respond to your body's needs, and keep it at an optimal state without thinking something has gone horribly wrong, just because you're feeling something. And there are a variety of reasons why somebody might have faulty interoception it could be trauma related, especially if your trauma involves a loss of bodily autonomy, or something became really overwhelming for your senses. This can cause us to kind of disconnect or tune out from bodily sensations because they didn't feel safe or were overwhelming. It could be neurological conditions, so any damage or dysfunction in the brain, things like strokes, traumatic brain injuries, lots of concussions that affect certain areas of your brain. Autism Spectrum Disorder is often associated with atypical interceptive processing. So individuals with ASD may have just more difficulty in general recognizing and responding to some internal sensations. Other things that can create some faulty interoception could be substance abuse or substance frequent use. Eating Disorders, conditions like anorexia or bulimia can really disrupt interoceptive awareness, particularly regarding like hunger and fullness cues, but also in general tends to just disconnect us from the body. 

20:28  
But I think most generally, and commonly for everyone, our environmental and experiential factors, so traumatic experiences, chronic stress, adverse childhood events can really impact how we perceive and respond to our body signals. The fast paced modern day society often has us ignoring sensations of thirst, hunger, needing to go to the bathroom for the sake of productivity, and that layers on over time, just disconnecting us from accurately reading and having accurate interception. 

21:05  
So maybe the system for you is on the fritz, you have some faulty interception, you feel disconnected from your body, or you aren't accurately interpreting these body signals, you're often filtering what could be potentially normal physiological responses, as something more sinister or more dangerous to your health. And the good news is that you can retrain this system, you can cultivate more accurate and safe experiences of interception. And this is the foundation of somatic nervous system work. And this is something we put a huge emphasis on in our work with clients. So how do we do this? How do we improve interception? And this leads us to our next approach, which is that education, education, and practice. 

21:56  
So education looks like that psychoeducation, about how your brain and body work, it's what this whole podcast is founded on. It is something I am so passionate about, that everybody deserves to understand their physiology and in doing so it normalizes so much of why we are the way we are, why we feel the way we feel why we experience and move through life in the way that we do. The number one thing I hear from podcast listeners is messages like oh my gosh, what you're saying just makes sense. My symptoms just make sense for the first time ever. And so education is what you're here, and you're getting, the number one step to heal from anything is to create a felt sense of safety in the body. And the number one way we do that is through understanding our autonomic nervous system. And the second thing is with a lot of practice, noticing moments of dysregulation using tools, people co regulation places to bring us back into a more felt sense of safety. So gaining a more informed understanding of your basic and normal physiological responses, is a really great start towards normalizing sensations and symptoms that are currently sending your health anxiety spiraling out of control. And we support our clients in this by helping them to map out their unique nervous system. And if you want to learn more about how to map out your different nervous system states, I have two episodes dedicated to that in the anxiety mini series and the depression mini series, so it'd be a great place to go next. And so we improve our interceptions through education, and practice. 

23:48  
And the practice leads us to the third approach to helping you to recover from health anxiety, which is somatic and nervous system regulation. This is the practice this is vital and what creates safety and trust over time in our body, helping you to rewire your reflexive nervous system patterns out of instinctually, defaulting to danger and threat to knowing how to source for safety. And this practice looks a number of different ways with our different clients. But it all has the same goal of how can we practice being in and with our body in neutral or safe ways. We often refer to this as befriending your nervous system. So this could be something as simple as respecting your bodily responses as they show up. So what would it look like for you for the next week to really focus on being in conversation with your body, maybe even saying out loud? Oh, I noticed I'm hungry and I know that I'm hungry because insert a description of your bodily sensation. Or oh, I'm tired right now. I know that I'm tired because insert what you're somatically experiencing in your body And then as often as possible, and as immediately as possible, how can you respond to or meet that need. That's what helps us to cultivate accurate interception. And then also a sense of self trust of body, I hear you. And I'm attuned to your need, and I'm going to meet it by giving you a snack by taking a nap or preparing to go to bed. Oh, yep, I have the urge to pee. And I know that this is the urge to pee because there is tension in my bladder, I'm gonna go to the restroom. And when we are able to notice sensations, notice the detail around those sensations in our body and then meet that need. That is what cultivates this interception helps us to befriend our body and our nervous system and cultivates self trust.

25:50  
Some practices that we do here also involve kind of mindfulness and somatic awareness to help you understand that you are not your thoughts, you are not your feelings, you are not the sensations, you and your body is simply the container that they pass through. And it is cultivating the skill to be able to witness your experiences and your thoughts without judgment and without necessarily trying to change them. Oh, my gosh, my heart is beating really fast right now. Okay, that's happening in my body, immediately, your brain is likely going to jump to are we having a heart attack? And can you have the awareness and the space to say, Oh, I noticed, I'm thinking I might be having a heart attack, there's a difference between the thought, oh, my gosh, I'm having a heart attack. And I noticed that I'm thinking, I might be having a heart attack. And we're looking at different tools and practices that help us to diffuse from these intense experiences to create a moment of pause, to be the observer of thoughts, sensations, and that's at the heart of mindfulness. Because what we do with health anxiety is we attach to these unhelpful thoughts, and we let it Spiral out. We don't have context around the sensations in our body, and so they cause us to panic. 

27:08  
So the goal here isn't to never wander, or to fear, the goal is to be able to close out that stress cycle, to have moments of pause, to be able to have your fear, have your worry. But to be able to move on with your life as quickly as possible or to be able to make choices of seeking out testing from a place of curiosity of competence of confidence instead of fear and anxiety. Because the reality is you are likely still going to experience that fast push of activation that comes when you hear a health related story, you go to schedule that appointment, you feel that pesky symptom in your body. But you absolutely can rewire your response to make more room for the oh, okay, it's fine. This is a sensation I felt before it's a sensation I've survived before my chest just gets tight my heart races when I feel triggered or anxious. And if I'm able to get more regulated, and there are still some symptoms, I again, thinking about that equation, I believe in my ability to source support to help me sort through this. And over time, as you can reset that stress cycle. Those wishes of anxiety become less and less and less intense. Because we give our brain and nervous system more context. We have tools that tangibly shift our physiology towards a more parasympathetic state. And over time, this literally rewires our amygdala to be less sensitive. That alarm does not go off as easily anymore. 

28:56  
And so the bottom line there is you have been filtering your symptoms and sensations through a lens of danger. And part of this work has to be coming into compassionate and safe conversation with your body. We do that through education, and through practice. And sometimes you can do this on your own. And sometimes you may need the support and guidance of a practitioner. 

29:23  
Which leads us to our fourth and final approach, which is CO regulation. And I even recently did an entire episode on the powerful role that connection, aka co regulation plays in our healing. So knowing you have health anxiety, take a moment to reflect on who can you put in your corner that helps you to feel more safe and regulated. Not just the person who can help you rationalize your symptoms or problem solve. But do you have a friend or a family member a practitioner who helps you to feel be less anxious to feel more safe in general. And the other side of this coin is can you identify the people who feed into the spirals who go down the rabbit holes with you, because those may be people to not take your health related concerns to in the future. 

29:24  
So like I mentioned, in part one, I personally haven't ever really struggled with health related anxiety for me, I have definitely been a bit catastrophic in thinking sometimes when it comes to my kids health, but rarely my own. But I have definitely experienced dental anxiety big time, which I think is kind of an offshoot of health anxiety. So when I moved to where I live now, finding a new dentist is part of that just like you've got to find a new doctor and mechanic and all of it but dentist for me, highly triggering. So I found somebody who had pretty good reviews online and I left in tears that turned into a panic attack. And it literally took every ounce of everything I had to get out of that dentist office and building before just letting it all out. I did not feel safe with this dentist he had what I felt like was an attitude that he didn't care he openly admitted that the only reason he became a dentist was because his dad paid for dental school like just so many things that were red flags. And I could feel it in my body. I might. My fists were getting tight. My heart was racing, my chest was closing it was getting hard to breathe. I could feel my eyes getting hot like all of my, all of my signs. 

31:39  
Now, fast forward about four years later, just last week, I sat in a dentist's chair for two hours straight. While he removed an old crown and got ready to replace it. Sitting in a dentist's chair for two hours. I then had to schedule a follow up 90 minute appointment for what's actually happening this week to have a new crown placed. At no point did I feel anxious. In fact, I was laughing with the front desk woman as I scheduled my next appointment and looked at the dentist and told him that I would reluctantly but gratefully see him in a couple of weeks. What a profoundly different experience. And yes, I have done a lot of general healing and nervous system regulation work in the last four years. So let this be your testament that it is possible to overcome the health anxiety if I can overcome my dental anxiety, it is possible for you to get to a place where your health anxiety no longer controls your life. 

32:44  
The other part of this is CO regulation. He being my dentist and even his incredible front desk staff have been a huge part of rewiring my dental experience with a sense of safety and calm and competence, their presence, the environment in the office. All of this has helped me to feel safe and supported in situations where that has not been the way that I've been held. So when you have the ability to and I know that this isn't a luxury available to everyone, but if it is even in small ways for you, I want to invite you to break up with the doctors, the dentists, the practitioners who don't help you to feel validated and seen and safe. And to seek out ones that will hold you in a more gentle and compassionate way. I wish that was easier to source for. But there are medical care providers out there who love what they do. 

33:45  
Unfortunately, most of them operate in a medical system that over books and burns them out. But in whatever capacity you have to be proactive in sourcing for practitioners that help you to feel safe, I would encourage you to do so. And another way to lean into CO regulation is to be intentional about book ending triggering experiences. So what I mean by that is when you feel triggering symptoms or you have a doctor's appointment, can you close out that stress loop? Is there someone something some tools that can help you source for a sense of safety to kind of reset from the stress response that is happening as a result of that symptom or appointment? Because when you have an episode where your health anxiety spirals out, or like I said you just go to an appointment and you can close out that experience with a sigh of relief with a sense of feeling supported by somebody else. So you can co regulate to this aids in very, very real rewiring it allow Use your brain and your nervous system to see. Oh, yeah. That felt really, really scary. But look, we're okay now. Look, we didn't die. Maybe we don't have to see that as such a life threat next time. 

35:16  
All right, friends, let's bring this all together with our three tangible takeaways. Number one, with health anxiety, you have a built in negativity bias that filters for health related things. So just realizing that the way you're perceiving things that especially health related, may not be an accurate representation of what is really there. This filter projects worry on to normal and natural bodily responses. Again, most of those bodily responses associated with that sympathetic activated state. So gaining education and awareness around your autonomic nervous system and normal physiology is crucial to helping you normalize your experience. 

36:05  
Number two, cognitive behavior therapy thought work has merit, but it often falls short on its own if your body is still in an active state of alarm. So co regulation and nervous system regulation tools help to rewire your reflexive nervous system patterns out of assuming danger and threat and into instead being able to source for safety. So if you feel like you have been trying to out think your health anxiety, you've been working with a therapist in this kind of CBT realm, and maybe it's been helpful, but it's, you're still not there. Try incorporating one of these other body based approaches. 

36:49  
Number three, the framework and suggestions that I have offered you today. These four approaches do nothing to help you overcome your health anxiety, if you do nothing with them. Just a reminder that this podcast is meant to educate, to inform and to invite you into being an active participant in your healing journey. Each week, I get to sit in front of this mic and talk a talk at you. But unless you take steps to walk the walk in your healing, nothing changes. So take a moment to reflect on your biggest takeaway from our conversation today. And decide where it might be helpful to focus your attention and your actions to next. 

37:42  
And as I have invited you so many times before and will continue to do so it would be an honor, I would love to walk alongside you in your healing. And if you're looking for support, a great place to start is inside rise my mental health membership and nervous system healing space. And there's always a link in the show notes to join us there. All right, friends, I hope that you have had some aha moments. I hope you have your own tangible takeaways on how you can better understand what health anxiety is, and what the next step might be for you to overcome it. 

38:24  
Thanks for listening to another episode of The regulate and rewire podcast. If you enjoyed what you heard today, please subscribe and leave a five star review to help us get these powerful tools out to even more people who need them. And if you yourself are looking for more personalized support and applying what you've learned today, consider joining me inside Rhys, my monthly mental health membership and nervous system healing space or apply for our one on one anxiety and depression coaching program restore. I've shared a link for more information to both in the show notes. Again, thanks so much for being here. And I'll see you next time.

Transcribed by https://otter.ai