welcome to part two with our discussion with uh dr sally winston and dr martin seaf and we're going to be talking about their book needing to know for sure so i want to start off by asking you both why did you write this book this book is a companion to our first book which we talked about in their earlier interview it's a companion because after we finish the first book which is essentially about unwanted intrusive thoughts or what is truly called obsession stuck thoughts we realized that there were there was a whole missing part to the to this um venture and that was that people who have unwanted thoughts or obsessions maintain their obsessions by compulsions and we weren't as explicit in the book about that and what we needed to do was to address compulsion in our in our books we have these three characters worried voice false comfort and wise mind and they discuss uh internally what goes on when somebody gets anxious and makes their own process worse and what we what the way that we envisioned it is worried voice was whatever a person thinks that makes them more anxious which is the intrusion of the what if or the worry thought and then false comfort was the attempt to make the anxiety that went with the first thought go away so we wanted to write a book from the point of view of explaining what false comfort is and false comfort is compulsion compulsion most people think of as being behaviors that people do repetitively to try and make yourself feel better but in fact an awful lot of compulsion is mental it's it's a cognitive compulsion it happens inside a person and you won't necessarily see it a lot of times people think that what they're suffering from is something they call pure o which means obsessions only and we don't agree with that we think that obsessions are always followed by some sort of compulsion either something you can see or something that's just in your head that's an attempt to make yourself feel better so this book is about the follow-up to that book in which we are particularly addressing the kinds of compulsions that are subtle and those are reassurance seeking and checking and both of those can happen in ways that are so subtle that people don't even realize what they're doing or how it's contributing to their anxiety so that's why we wrote this book well what is wrong with what is wrong with seeking reassurance and checking what's wrong say something let me answer that um there's nothing wrong with seeking reassurance or in fact it's normal to get reassurance the problem is that most of the time with most people reassurance sticks you hear some information oh okay and you move on but occasionally sometimes and for some people often that reassurance actually provides a temporary relief but it doesn't stick you become unsure again and you want additional reassurance so in fact what happens is that we use the term reassurance junkie an example because you become more and more needing of reassurance so the reassurance provides a temporary leap of anxiety that would be what a compulsion does but that reassurance and temporary relief of anxiety is actually the engine that drives the next what if obsessive concern some way now another aspect of that i think is important about this book needing to know for sure is that most people have heard and even understand the concept the the treatment for uh obsessive compulsive disorder which is called exposure and response prevention and in fact what that means is we expose ourselves to something that creates anxiety and then we don't do the thing that we do to kind of reduce that anxiety and if we look at that from a purely behavioral model a person is their hands are dirty and we say to them don't wash for the next hour it seems to work but in fact very often a person will be sitting there for the hour thinking to themselves i can't wait when i get home i'm going to jump in the shower and i'm going to really scrub myself from head to toe and that is a mental compulsion in some way so in fact the whole idea of quote unquote response prevention is much more complicated and requires much more inspection than people than the do people usually give to it and that's one of the things that we try to address very closely in this book what ways do you very subtly get yourself to feel better rather than allowing the feeling that this obsession creates and allowing it to be there and as you're doing other things that's a big important concept sally likes to emphasize that all the time and i totally agree with her we do things techniques or whatever not in order to reduce our anxiety we do them while we're feeling anxiety in order to stay as connected to the present as we possibly can that's what we're trying to do it's a subtle distinction but it's an essential distinction in some way would you agree with that sally i hope you would yeah i i think another distinction we make in the in the book um is between and this to answer your question is between productive reassurance and unproductive reassurance and that's that's what marty was saying is that this book talks about unproductive reassured seeking which actually keeps anxiety going and actually makes it worse and that can be so subtle that you don't even realize you're doing it um you and people will uh have all kinds of ways in which they seek reassurance that is um even just what what they might have been taught in therapy or what they might have been read in a in a self-help book that is actually some kind of repetitive coping skill that is actually making things worse because they are over and over again reassuring themselves and they almost anything can be turned into a compulsion and that is a very subtle process so that's why we wrote the book that's what we want people to see is is that self-talk can be self-reassurance in a way that's unhelpful if you're constantly saying to yourself i probably won't get sick i work with a lot of people with go ahead right yeah i work with a lot of people with um health anxiety so if they see a mole and the what is that mole and maybe they'll ask a relative or their mom or spouse do you what do you think does he think the small is okay and and you know maybe the spouse says yeah it's fine but i guess if you keep asking over and over it's just not enough well actually we call we have a term for that we call that empty reassurance and empty reassurance is getting reassurance about something from someone who knows nothing more than you do so if a patient says to me do you think the small is cancerous i say to them you can go on the street and talk to anyone walking on the street and ask them do you think the small is cancerous you know i know nothing about that so if so essentially people become addicted to they become a junkie i mean that's a derogative term but that's they become addicted to empty reassurance or a cell who would say unproductive reassurance in some way it's very common with health anxiety right and if you go to the doctor and the doctor looks at them all and says no the mole is fine and then you go home and then for the next two weeks you keep telling yourself the doctor said it was fine the doctor said it was fine that's self-reassurance yeah what more often happens is you don't start with the doctor said it's fine you have the thought but that maybe the doctor didn't look at it carefully enough and then you say but the doctor said it was fine i think it's changed and maybe i should should i go back but maybe i'm too embarrassed maybe but maybe i'll take a look at the internet and see pictures of moles and then we're going to work on that and that's it and then what but wait a minute was that mail which is a good place as opposed to webmd which isn't always a good place and on and on and on because what you're seeking is that relief that you feel in that moment in which you're addressing it so yes it's it's actually part of health anxiety as you're talking about it that's an essential piece of health anxiety is that checking so what is therapeutic surrender do you want to take that no okay therapy look you know part of it is what we're trying to do is teach people a um an acceptance based model of of anxiety a kind of change both in their perspective the way they look at anxiety and also um a change in their attitude towards anxiety which is essentially there's a natural desire to run away from anxiety to avoid but unfortunately anxiety is paradoxical and avoidance in the long run only increases anxiety so we're we're trying to create a a vocabulary for for for the people that we see to say listen i want you to ch i'd like you to be able to change your attitude towards anxiety i'd like you to be able to lean into it i'd like you to allow it i'd like you to open it open yourself up to it in some way which people and which which initially patients are well what are you talking about so we started using the word well we want you to surrender to it and that was even worse you said oh my god the united states surrendered to my anxiety disorder so we came up with the term therapeutic surrender which essentially means it's the it's the it's it's a it's an attitude towards anxiety which allows opening for it and essentially allows you to um have the feelings there while you're doing something else you know i kind of it's a switch into willingness to have the experience you're having instead of be struggling against it and we teach we we teach in the book ways of understanding it that are often using metaphors yeah here's a metaphor that i like to use what sometimes i it doesn't do that well with zoom but i'm going to try to do i see a little picture of myself i say look anxiety can actually become like this when you're really anxious this is the whole thing okay this is i understand you can sort of push the anxiety to the side you see that but you're really it's still there it's not nearly as bad but you're you're pushing it to the side in some way and so i say to someone again i'm going to try it i don't know can you can see why i said left here put it on your lap put it down it's still there but you're not working anymore and you still have your hands free you can type at the computer you can make yourself a cup of tea you can get involved with the present it's still there as opposed to trying to push it there so what we're trying to do is give metaphorical ways of presenting allowing something to be there surrendering to something there are many metaphors while your body takes care of itself and that's something that's a good psycho education for people to realize your body will take care of itself as you stay connected to the present so one another metaphor that i like to use is the tug of war metaphor which is really surrender if you think of your anxiety and you matched on two ends of a tug-of-war rope and your anxiety is pulling you one way and you're pulling back and you're pulling and you're pretty evenly matched and you're just back and forth back and forth and i asked people what do you think would happen if instead of pulling with all your might and possibly getting anxiety to come a little bit your way what if you simply drop the rope what's going to happen and then everybody does this because the anxiety on the other side with no no opponent um it falls down and that's no more struggling no more struggling that's what therapeutic surrender is and it's not a way of suffering forever it's a way of being willing to go through something so that the suffering will solve itself and it does that's the most efficient way and the quickest way to to become less anxious yeah right so needing to know for sure you can't know for sure in all your attempts you'll never know for sure there's no 100 percent certainty and if you demand 100 certainty you get to keep your anxiety disorder right right that's very true well thank you guys very much for sharing with us your wisdom about needing to know for sure and if people are interested in learning more about that feel free to pick up the book on amazon and thank you guys very much for uh being with us today